Pakistani families spend Rs248bn yearly on formula milk

ISLAMABAD: Pakistani families spend an estimated $888 million, equivalent to around Rs248 billion, annually on infant formula milk, while approximately 33,700 children die each year due to the absence of breastfeeding, paediatric specialists have warned.

The figures were presented at the 28th biennial conference of the Pakistan Paediatric Association (PPA) in Islamabad, where medical experts discussed major challenges affecting children’s health, including malnutrition, infectious diseases, heart conditions, air pollution and adolescent care.

Professor Khalid Shafi of the Sindh Institute of Child Health and Neonatology said infants under six months who were not breastfed faced a 15-fold higher risk of death than those exclusively breastfed. He said diarrhoea and pneumonia were among the leading causes of these deaths.

According to the specialist, inadequate breastfeeding also imposes an economic burden on Pakistan, costing the country approximately $2.8 billion annually. Exclusive breastfeeding currently stands at 48.4 per cent nationwide, while the under-five mortality rate is 58 deaths per 1,000 live births.

Prof. Shafi expressed concern over the marketing practices of formula milk manufacturers, including promotions involving social media influencers. He also highlighted concerns about industry-sponsored activities for healthcare professionals, including conferences, gifts and overseas trips.

He said manufacturers had challenged Sindh’s 2023 legislation regulating the marketing of breast milk substitutes. According to him, the companies had lost their challenge in the high court and subsequently approached the Supreme Court.

The professor urged the PPA to enforce its boycott of commercial sponsorships and called for stronger penalties, product recalls and harmonised legislation across the country to protect breastfeeding.

At the conference, Professor Masood Sadiq of the University of Child Health Sciences in Lahore highlighted the difficulties in identifying heart failure in infants, particularly during their first three months of life.

He said congenital heart disease, rheumatic heart disease, myocarditis and severe anaemia were among the major causes of heart failure in Pakistani children. Anaemia affects approximately 57 per cent of children under five, he added.

Prof. Sadiq said symptoms such as an enlarged liver, feeding difficulties and rapid breathing should prompt early medical assessment. He also pointed to the limited availability of extracorporeal membrane oxygenation (ECMO), an advanced form of life support, in Pakistan.

Professor Ejaz Khan of Shifa International Hospital raised concerns over the spread of extensively drug-resistant typhoid. He said the proportion of resistant isolates increased from 28.2 per cent in 2017 to 64 per cent in 2019.

He emphasised that blood culture should guide the diagnosis and treatment of typhoid rather than relying on Widal or Typhidot tests. He also stressed the need to preserve the effectiveness of azithromycin.

Pakistan introduced the typhoid conjugate vaccine into its routine immunisation programme in 2019. However, the reported impact after two years stood at 48.9 per cent in Sindh and 66.2 per cent in Punjab, with protection declining over time. Prof. Khan suggested considering a booster dose at the age of five, alongside improvements in clean water and sanitation.

Professor Aisha Mehnaz warned that air pollution was creating serious health risks for Pakistani children. She said fine particulate pollution levels were more than 13 times the World Health Organisation’s recommended guidelines.

She estimated that pneumonia claims around 70,000 children’s lives annually in Pakistan, while asthma affects up to 20 per cent of children. She called for measures to reduce emissions from vehicles and industries, prevent the burning of crops and garbage, and expand public transport.

A separate presentation by Areeba Sultan of Aga Khan University examined 150 child deaths in Karachi. She reported that 81 per cent involved stillbirths or newborn deaths. Perinatal asphyxia accounted for 25 per cent of the cases, followed by sepsis at 13 per cent and malnutrition at nine per cent.

The conference also highlighted shortcomings in healthcare services for adolescents. Dr Mehak Naeem presented a survey of 91 healthcare providers, which found that 90 per cent lacked dedicated inpatient facilities for adolescents, while 78 per cent had no policy for transitioning young patients from paediatric to adult healthcare.

Professor Muhammad Idrees reported that new paediatric HIV infections had increased from approximately 530 in 2010 to 1,800 in 2023. Only 38 per cent of children living with HIV were receiving treatment, highlighting gaps in diagnosis and access to care.

Professor Jamal Raza, executive director of SICHN, drew attention to under-recognised endocrine disorders among children, including type 1 diabetes diagnosed at a late stage, untreated congenital hypothyroidism, growth disorders and rickets. He attributed the problem partly to weak screening programmes and a shortage of paediatric endocrinologists.