Infant mortality and childhood nutritional status among Afghan refugees in Pakistan.

Female health visitors interviewed 1512 families in 1984 and 1566 families in 1985 dispersed among Afghan refugee camps in the provinces of the Northwest Frontier Province (NWFP) Baluchistan and Punjab in Pakistan in Pashto the language of most of the refugees. The refugees came to Pakistan as a result of civil war in Afghanistan. Infant mortality fell from 156-119/1000 but the difference was insignificant. The researchers believed the consistent direction of the differences to be real however. A 3.7% increase in the percentage of children who lived to age 5 and a 9% increase in children above the standard weight for height median occurred between 1984-1985. Further 1.2% fewer children were malnourished in 1985 than 1984. Moreover no children in either year were <70% of the median. These improvements coincided with a shift from tents to permanent dwellings; more livestock vegetable gardens enclosed water supplies and in near urban camps electricity. Despite these improvements and readily available oral rehydration salts diarrhea still was the major cause of death especially for 1 year old children. In addition no change occurred in the percentage of children who had diarrhea 1 week before the interview between the 2 years. Vaccine preventable deaths increased between 1984-1985. Specifically neonatal deaths from tetanus rose from 22-28%. Further 10 children died from measles in 1984 whereas 27 did in 1985. 24% of children in 1985 had measles. In 1985 researchers estimated previous access to immunizations by the presence of a BCG vaccine scar. 45% in NWFP and Punjab had the scar while only 26% in Baluchistan had a scar. Moreover infant mortality in Baluchistan was 2 times that of the other 2 provinces. In conclusion relief workers should implement control measures in Afghan refugee camps that reduce neonatal and infant mortality.