3.

HEALTH STATUS
"iiliil
The current situalion of key health indicaiors of District Khairpur highlights the need io improve the
performance ofthe health system in order to achjeve the targets set in ihe l\lillennium Development
Goals (MDGS). Some efforts have been made in the recent years, bui these effofis have not been
able to produce the desired results, due 10 the high magnitude of problems A number of laclors
contribute to ihis situation. Some ofthese factors are related io ihe health system itself; whlle others
are linked to related sectors like education, pubic outreach and flscal planning. Among lhese
contributory factors, the iow level of literacy especially among females and rapid increase in
popLrlation are of key significance. The scarcity of resources and financial constraints pose an
addiiionalchallenge. So, prioritization, setting 6lear targeis and effective and efficieni utilization oi
avallable capaclty and resources is of paramount importance

The following description of health secior in Khairplrr highlights the need foriaking actlon lifoctrses
on the major iss!es in each area of health and presents issues for aciion planning The areas are
described according to their importance and linkage with key health goals beglnning wiih a
discussion of maiernal health.

3.1. Status of Maternal Healthcare

Sindh Heallh Sector Strategy 2012-2020 and lhe srh Millennium Developmeni Goal underscore the
need to improve ihe quality and accessibility of maternal services, parlicularly in rural communities
These policy commitments manifesi high-level readiness and devotion io establishmeni of high
quality and accessible maternal care systems. ln spite of these effods, maternal mortality has
recorded the least progress during ihe last decade According to the Annual DHIS report 2013, 61
maternal deaths were reported by LHWS.10

The ,inks behveen antenatal care and maternal mortality are well recognized. Proper antenatal care
can help ensure a better pregnancy outcome, a healthy motherand a healthy baby, but coverage of
antenatat care remains inadequate Khairpur, as according to PSL[4 2012-13, 52 percent of the
ptegnantwomen seek pre natalconsultaiion. Among those, who received antenatalcare,28 percent
antenatal care services were provided by the public sector facilities whereas 44 percent of the
i services weie provided by privale seclor. Fifty-five percent ofthe pregnanl women received Tetanus
Toxoid TT immunizalion; and Khairpur ranked 14th among all the districts in Sindh with regard to TT
I
t
immunizalion.ll Acco.ding to the Annual DHIS reporl2013,77 ,997 vtamen received antenatal care
I and 29,091 pregnant women recejved TT-2 immunization from public sector faci iUes.l:
I

r0 Depariment of Health, Govemment

of Sindh. 2013. Annual DHIS Report 2013.
l 11 Federal Bureau ol Siaiistics, Government of Pakisian. Pakisian Sociai and Living Siandards N4easurement
1
SLrrvey,2012-13
i 1'zDepartmenl
of Healih, covemmeni of Sindh.2013. AnnualDHLS Repor]2013.
1
 Health Situation in Khairpur
----.----
Skjlled Birth Attendance is one ofthe pre-requisites
for reducjng morbidity and morialjty of
mothers
and newborn. Accordjng to pSLM_2012_i3, jn
I Khairpur, only 36 percent deljveries
were condLrcted
by skirjed Bjrth Attendanis (sBAs).
overal, 7 percenl ofthe derjverjes took prace
in the pubric sector
facijities, which is an ararming sign
nt with regard fo the performance of pubiic
secror.13 The post naial
coverage was reported to be qujte
)n row as wel onry 22 percent mothers
consurted a health facjrity
for postnalal care. Sjmjiarto deijverycare,
the share ofpublic sectorfacitities in provision
of postnaiaj
fs care was also a mafler of concern.
Among moihers who received anienatal
care, onJy 21 percent
visjted publjc sector faci,ities for posi
se nalal consultations; wh;le 54 percent vjslted privaie
in
hospiiaJs/clinics
1a

3n

lssues of Maternal Health in District

Khairpur
During the year2013, 6.1 maternal
deaths were reported by LHWS jn
Annual DHIS report.
lre 28 percent (out ofs2 perceni) pregnant
women received antenatarcare in pubric
sector
facijiiies.

55 percent pregnant women received

TT jmmunization
Overaliskilled birth attendance was
36 percent; only 7 percent deljveries
took place
he in public sector faciliijes.

Postnatar care coverage was 22 percent.

gh Among those who received poslnaia,
care,
laS onry 21 percent v;ii.ed publjc sectorfacillies.

61

,re I\,,laternal health in Khajrpur

is beset wjlh i
rof care io weak arransem"n,",o,.,"nun",l,lT*il:ffi :Tr"":J:il"""J,;rjff
he insufficient coverage of rural areas
by cornmunjty heallh workers,
:::J,:,
Iow utilization of avajlable rural
eni heaith faciljties and deflcjencjes jnstitLiional
in care. Health initiatjves have noi been
able to cross
lhe all baniers io accessjng healthcare in
th efforis so far despite making maior
achievements'
Therefore, during action p1anning there
IUS is
requjrements to focus on Jow usage
of anlenatal and
TT postnatajcare, hearth promotion
oimothers gh adequate knowledge dissemination
ol dietary and hygjene practices affordabr€ foradoption
are uno t"'"u"" to the coniext' upgrade
investments in iargeted soltrtions refe,al syslems'
fo,. ,"na
comprications ancr
incentives ror pubric ano
,,,uu," n"u,,n,,",,lil[]J;i,"rtj,:ffi':"chirdbirth

'r Federal Bureau oistatisrics, covernmenl rrakistan.

5rNey,2}12-13. _',
^r Pakistan socialand Living standards
lr4easuremenl
1'1
ibid
 I

According to AnnLral DHIS Report 2013, 32,400 family planninq visits were conducted at health
facitities-15 This situation necessitated renewed efforts to improve the level of awareness about
fam;ly planning.

Figure 3.1. Siluoiion of Moternol Heolth in (hoipur

r Sindh
a Khairpur

i TT lmmunizaiion Skilled Birih Atiendance PoslnatalCare

I
3.2. Status of Child Health
lnfant and under-five mortality rates are the most widely used indicaiors of health status and socio-
economic development because they reflect not only child modalily levels bul also the health status
of the broader population. The fourth [,4Dc calls for two third reduclions in under-flve mofallty raie
(Us[rR) and infant mortality rale (l]\rR) bet!,r'een '1990 and 2015. Similar io the rest of districts of
Sindh, Khahpur relies on survey data to measure inlant and childhood mortaliiy because essential
registralion and heallh informaiion systems are not adequate forlhis purpose.

Districl specific figures are not available; however, analysis of variables related to IMR and UEMR
in the province rcveals that children in rural areas of the province are at higher risk of dying before
5 years of age compared to urban areas. Two thirds of infant deaths in Sindh take place in the
neonatal period, mainly jn the intra-partum and in the early neonatal period offirsiweek of life16.

'sDepdlne I of Hedkl-. Gove,nn err ot S:noh. ?triJ. Arn_at DHtS Repon 2013.
t Bhuti" ZA. Sajid Soofi,S mon Cousens, eiat.2011. Ihe Larcet. tmprovemeni ot perinaiatand
newborn care
rn ru ral PEkisla n th roug h corn mu nity-based sirategies: a ctu ster,16ndomised effecriveness triat, 377(9763)i 403-
412

$
$
I
 Heafth Situation in Khairour

th Tqble 3.1 Chitdhood Mortotify lndicolors

of Sindh province
ul

lnfant l\y'ortahty Rate (per 1,000 hve brdhs)

Neona tai t\,Ioda ty Rale (per 1

,000 | ve birlhs)
lJrder5 N4orlatity Rate Jper 1,O00 tive birlhs)
93
SourcerPDHS 2012J3

3.2.1 . Childhood Illnesses

Diarrhea
is
a major communicable disease of children under 5 years of age. Revjew
of national
surveys
;evealed that S percent of children under 5 years of age suffered
from djarrhea during 30
daYs prior
1o 5grvsyrz. preveniing dehydration and malnuiriiion by
increasing fluid intake through
of orat rehydration therapy (ORT) and contjnuing to feed are key strategies
,ll.: "r.Diarrhea can
"'drrhea.
to manage
be cost effectjvely managed at community levelwiih zinc and oRS.
ORS use
'n
*,Orun *rn O'urrn"a has steadily increased and Khairpur js ranked j2rh among djstricts oi Sjndh.
' '., 91 percent of the childhood diarrhea
'otrpur, cases were consulted with a healihcare provider
g1 percent children were given ORS io treat the
lnd
clb- dehydration. Compared to urban areas. use oi
- 'o \^/as slightly tow in rJra,Kha;.pu, w,th 9t perce,tt
.oto,"r.hu".u."a O",,tg treated with ORS.1s. planning ln 2013, 124,463 cases ofdiarrhea
ror adoptlon of prevention practrces and
appropriate among children under 5 years of
lno t,au', treatment wlll results in early childhood age were treated jn the outpatient
'realth gains through reduction in dia.rhea-reJated departments of primary and
p- lleaths. secondary level facilities in Districi
US
acLorciing Kha 'our'
te to the Arnua DHls Repori 2013. number
)l cases sour'ei Ar_ua DHls Repo12013
ol of s.rspec,ed preu.ronla i- chirdre. r.rder 5
ial
-^-.'l "t .S" was a9.7aA.'" Mala- oeterni-arts o. nealth seeling behavo. Ior pneumo.ia we.e
'uwledge of rnothers and caretakers about danger signs
^
:DFropriate of pneumonia. Using these facts,
interventions can be adopted ro increase hearihcare adopiion and
IR timery allention. The
levels of awaTeness of danger
signs contribute to mismanagement and delays in seekrng
='^w
:'propriate care for children suffering from pneumonia. Appropriately designed messages
=_.to shoutd
,others, attention ioward ihe danger signs. At the same
'euld "uOr""r.. oftreatment
Ume, efficacy
be emohasizert

_:e-dera BLrr6au ofSrarstics. Governmenl o

_-,"r.ioiilij"","dtr:uLs,uuverrmenrofPakistan.pakistansociaranclLivinssiandardt\4easlrrement

D3
lspartment
of Heatth, Govemmenl ofSjndh 2013 Annua DHtS Repori2013.

10
 H"'lth Sl""tl"" lffi

lmmunization preventable Diseases

lmmun]zationofchitdrenhasresultedinsignificantreductioninmorbidityandmorta!iiyinsindh,
percent compared to
Khairpur has immunization coverage al 76
Or""n * OnU,",t of Sindh'
province in terms of immunizaiion
percent' The district is ranked 12th in the
ir"","'",r, """ran"
""
coverage2o.

Figure 3.2 ComPorison of

immL'nizotion stotus in KhoirpuqryIl'9

l
l
3.3. NutritionalStatus
of Nalional
siatus particularly afflicts women and children in district Results
1
Low nuiritional
disturbing irends as children suffering
from chronic
1 Nutritional Survey-2o1'1 have yielded
wiih deiiciencies
issue is complex and widespread'
I malnutrltion in Sindh have increased' The
intake of these
other health problems due to insufficient
Il ranging from proiein to iocline, along with
for economic gro\"'th and development
Usinq
l esseniial nutrienls. Malnutrition has implications
in terms ofyear
t macroeconomic costs are considerable
I household levelestimates, it is obvious that
(GDP) foregone For example'
just three types of malnuiriiion
in, year_oui gross domestic procluct
Pakistan in any given year'21
are responsible for 3-4 percent oJ GDP loss in
L to dia hea'
District KhahpLrr can be attributed
Large toll of infant and childhood deaths in
hides ihe
But thls simple way of classifylng
pneumonia, malaria, and vaccine_preventable dlseases'
ln pariicular'
bui a process with many causes'
{act that death is not usuatly an eveniwith one cause
downward spiral
which pr'rlls many chlldren lnio the
it is the combinailon oi malnutrition and inleciion'
of malnutriiion are available
of poor groMh and early death. Low-cost methods of reduclng all forms
irnprove nuirilion and to protect aqainst
an.i have been shown to work- Action on both fronts - io

Me2sLremenl
,o FederatBureau oistaitsitcs, Governmenloi Pakisian. Pakistan socialand Ll''no siar{iard

?i,l,il;j'-t"1Jf" commrflee on Nurriiion (scN).51h repod on ihe

wodi .,,.-:.1 s]tLration, 2004'
""* "s

11
 disease - could save many more ljves
(and be far rnore cosi_effective) than action
on ejther front
alone_22

Heaith education should emphasjze

good Illtritional practjces that are
affordable for djfferent types
oicommunilies. Micronutrienis and
essential nutrients use shoujd be promoted
through involvernent
of private sector. On ihe one hand governmenl prograrns
can generate demand for such prodLlcts
and at the sarne lime on the other
hand
improvement in nutritioo ,,"
",pn,"i"
oilliiiti;::flffi:i::: ffi':::J:",.ffi:ff:::
multi-sectoral programs_ Where posslble, ii should be explored
if nutritional supplemenis could be
made paft of antenaial intervenijons promote
to healthy chiJdhood.

3.4. Burden of Communicable Diseases

From childhood to elderly, communjcabk
and djsabjiiry jn the Djsrrict Khajrpur
,;"ffi;:Tj:ffi:::J:::"::j":;:,",J
major achievements in healih goajs. ":"r:T:
3.4,'t. Acute Respiratory lnfections
Acute Respiratory Infections are
among the commonest causes of ill
health in the wortd. WHO has
estimated that one third ofthe I
deaths among children under 5 years
of age are dr.re to ARl23. Lack
of access to health services further jncreases 1

the risk of death from ARl. The faciors predisposing

to ARI include overcrowding, I
, exposure to indoor cooking and poor
nLrtriiionri. ARI has the highest
conkibution io the overali burden
ofdiseas(
wereireatediniheoutp",,"r,o"o"nr"*"rJloo,,'i::ij.I|:]fi:1,I:;;::':1i:ffi:r:: I
s
cfthe bLrrden ol djsease in the dlstrictr5.
This was the largest contribution to
overali burden ot disease i
by a healih problem, indicaiing the
role of ARI in the morbidity and rnoriality l
s in tt,u ai"trl"t,
'lecessitaiing urgent and comprehensjve "na
l- remedialmeasures during action planning.
rn
3.4.2. Malaria
l'lara'a is a disease thai disproportionatery
a, affects the poor due to prevairing environmenial,
socioeconornjc conditjons and the epidemiological
situation. ln Khairpur, a total of i14,360
suspected malaria were treatecl cases of
at the olrtdoor patient depadment l
in pub{ic faciJities. This was
:econd highest contribuiion by
?l a djsease to the overall burden of jn
djsease the districtrd. Malaria js
j
rle

Progress ofNanons. The Narions

oftheWor. rher A.h'".eme''( ir cl,,o Led,r
'-:'i'o1 fo r arol Fa- ,r) pral .ins *" ,,"nli:;1 ""'o';8Jo

.'/ebberR. A.ute Respi,atory

tnfe.rions. Com

_
i ilx".;:5i]::'J"; ;, : :",:'" r:" "";:"^;"::::11 "1':i.txi"t1l.!;jJ!l;j""",
iepariment ofHea h, GovernmenlofStndh
2013 AnfuatDHIS Repo.t,20j3.

1:

12
 pregnancy as ii affects aboul two in every 10 pregnancies in the
also a critical heaTth problem durlng
are quite iow in the district' IValaria
province. Household practices to prevent disease transmission
control may benefit from prompt, high qualiiy and cost-effeciive diagnosis for effeciive case
;n the portfoljo of options for acuon pianning'
management2T which can be adopied as a measure

3.4.3. HePatitis
Estirnated prevalence of Hepatitis B and c is respeciively
2.5 percent and 5 perceni, respectively,
linked to use of contaminaied needles
in Slndh compared to 3 and 4 percent nationally' These are
by health providers and quacks and Pakistan having one of
the highest iniection per patient rate in

the world, with 90 percent of injections given being unnecessaryfor

ireatment' ln order to skengthen
in immunization program While the
the efiods againsi Hepatitis B, its vaccination has been included
i A and E'
..ntamlnated water and unhygienic practices are ihe key contribuiing facior for Hepatitls
l
L
ln 2013, total of 7,396 suspected cases of vkal Hepatltis were treaied in
the outpaiient departments
i
; of primary and secondary level public sector facilities'?s
l
i:
i
3.4.4. Tuberculosis
i Pakistanisoneofthe22countriesthatstillhaveendemiclevelsofTB,wiihanestimateof353
I
i poor' According lo the Annual DHIS
cases per 10oo population, and a caseload mainly amongst the
I Report 2013, 7,127 suspecled cases of Tuberculosis were heated in the outpatieni
departments of
of disease
1
public sector facilities in the disirict, which aaiounted for 0 33 percent of overall burden
1.
Fast Bacilius; and
in the districi. DLlring 2013, 10,584 slides were examined for diagnosis of Acid

I '1,581 otthese slides were positive2e.

ii
i 3.4.5. OtherCommunicableDiseases
ln addition to aforementioned communicable diseases, which share the lion's share ofthese
I healih

problems, other 6ommunicab e diseases in the district include Otitis Media (52,613 cases)' Scabies

l
1:
(161,739 cases) and Worm infestaiion (22,359 cases)3o.

ii
l 3.5. Burden of Non-communicable Diseases
i Non-comrnunicable diseases (NCDs) encompass a group of preventable diseases linked through
common rlsk faciors including cardiovascular diseases, diabeies, chronic respkatory disorders and
cancer. Both NCDs and ;njury are amongst ihe top ien causes of death and disability ln Sindh as
I
I well as in Khalrpur. These diseases impose heavy economic burdens on communities and health
ir.

f'
f
$ 27 Muhammad A Khan, John D Walley, [,4uhamned A Munir, Muhammad A'Khan, Natryar G Khokar,
Zadishan Tahir, Alhar Nazjr and Naz; shams (2011). District ievel e(ernal qualltv assurance (EOA) of
fi malaria microscopy in Paklstan: pllot inrplemeniation and feasibiily, Malaria Joumal, Vol 10, pp.10-45'
f, Depafiment of Health, Governmeni ol Sindh. 2013. Annual DHIS Repod, 2013.
E '?8
Depadment of Health, Governmeni of Sindh. 2013. Annual DHIS Repori, 2013
fi "
E
ft 13

fi
F
$:
 systen'ts. ln a majorlty oi cases the
economically procJuciive workforce bears
the brunt ol these
ia drseases. ln spite ofthis reatjzation,
no signiflcant aitempts have been rnade to study NCDs palterns
in populatlon. Amongthe cardiovascuiar.Jiseases
in dlst ct Khairpur,58,460 cases of H yperlensjon
were presented ai public facjlities
foltowed by 5,051 ischemic H6ad Dlsease
cases.3r Arnong
respiratory disorders, total of 85,798
cas(
pu monary D seases
were repofted.
cases were reported during the year
r"J: :lj:'::il:: ;::j: :::1;::#:: ;j::1;
'! 2013 from Diskict Khairpur; while 37,425
cases or Drabetes
l\lellitus were repoded at publc facllities
during the yeat 2O133z
in

3.6. Accidents and lnjury

lnjuries result in rnajor economic Joss
E to cor
its on the vicrims and thei,.iu,,iri"s. woro.,".,l#ffi."|iiJ.,"jf :J:ffJHff:J;[:::"J
pojsonings and firearm injuries
were the predominant forms of injuries
occurrifg in the colrntry33.
Table 3.2 shows types ofaccldenls
and injuries jn the Dlstrlct Khairpur.

Toble 3.2 Types of Accldehts ond tnjuries

by Mognitude (in percentdge)
53
iS

Road lraiiicAccidenl
14139 888 1s,a2t 069
Fraclures
1 319 17A 1 489 0.07
Buns
3,471 3,149 0.14
Dog blte
7,460 999 8,459 0.39
Snake brte
217 215
ilth 001
Source: Ann uat DN lS Repo( 2013

3.7. Health Seeking Behavior

According to pSLM 2012-13, 1g.g4 percent
of ihe poplllailon uses public sector
services in Khairp!r
as compared to 16.9 percent in Sindh province
rgh and 74.48 percent using prlvate practilioners
versus
77.49 percent in the provjncee. Sindh
:nd has il
prjvaresectoruijrizatjon,","",,"n,nn,,o"',"nllnl"",l:Tff:[l]::::iffi1ffi:]iffllill,
ath

Depa'imenr of Hea th, Government of Stndh.

:] 20j3. Annual DHtS Repofi, 2013.
' GhafiarA Hyder,A,A, L4asroor[4
.urcyl,ani999i14(i);11-7 Shath .l'r;es jn Paklstan I dlrecuo is for fuiure health poticy Heath

"rsi"i"r,rs co!e,.me-rcipaksian pakistan socjarand

Livris srandard r,leasL,remenr
"',::X"'il?j'i"'
35
Departmeni of Healih, covernment
oi S n.f. 2C12. S iLation Anatysis lor Sindh
Healih Secror Straiegy

14
1:

Health Situation in Khairour

l

percent of U5 children became sick or injured during two

2.16 percent of adult population and 2.77
weeksprecedingthePSLM20l2"l3surveyand95,9lpercentofadUltsandallthechildrenrece]Ved

3.8. Water and Sanitation

is a human right as well as a basic
SLrstajnable access to safe drinking water and basic sanitation
necessity good health. Various health problems includirlg diarrhea' cholera' typhoid and
for
polluted wiih chemical' physical and
l dysentery are water borne. Drinking water can also be
drinking
l contamjnants, which may have harmful effects on human health Access to
mlcrobiological
primary responsibility
i water may be especially important forwomen and children who oiten bearlhe
surface
l for carrying water, parlicularly in rural areas3TAcross the country water sources, including
i and qroundwaler are contaminated wiih coliforms, loxic metals and chemicals due
io human
i activities such as improper disposal of effluents and use of agrochemicals3s' Both microbial
and
I
10 percent
l chemicalagents produce publjc health problems- According to PSLN"I 2012-13, overall
I (9
of the populaiion of Khairpur have access lo iap water, with considerable difference in urban
l perceni) and rural (11 perceni) areas. Khairpur is ranked
'131h among the districl of Sindh in terms of
j
availability of tap water for the household3e.
I
l
Mismanaqed sewerage & sanitation sysiems, ln both urban & rural setting, are causing further
I.
reduced
1. deterioration of environm enial pollulion. Presence ot a flush toilel is strong ly associated with
I
l risk of infant death, with ihe infant mortaljty rate in households having a flush toilet being significantly
I lower lhan in households without st]ch a loi]ef0, tn Khahpur, access to flush toilet iS low compared
I to provincial average, as only 39 perceni of lhe households have access to flush toilet in Khairpur'
i il Sindh''.
l co'npared to 63 perce.l(
t"
l'.
t
i
l
I
II
I
I
I
I
I 36Federal Bureau ofstaiistics, Governmeni ofPakistan- Pakistan Socia and Livlng Siandard Measuremeni
Survey,2012-13.
37 Faheern
Jehangk Khan and YaserJaved (2007) Deliverlng Access to Saie Dn nking Water and Ad equaie
I Sanltation ln Paklsian, PIDE Worklnq Paper,200739
I 33 Azizullah
Azizullah, Muhanrmad Nasir Khan Khattak, Peter Richier and DonatPeter Hader (2011) Water
1..
polluuon in Pakistan and iis impact on public healih A review, International Volu.ne, February 2011,
pp.479-497 -
3e FederalBureau ofstalistics, Governmeni of Pakstan. Pakisian Socialand Living Standard Measuremeni
Suruey,2012-13.
ll a0 Jannifer Benneti.
Correlates of Chitd l\lortatiry in Pakisian: A Hazards ModelAnalysis. fte Paklsfa,

t
IL
Develapment Rewew, /999i 38 ):85 ]]8
ar Fedela Bureau of
SuNey,2012-13.
Stalrsl cs. Government of Paklstan. Pakisian Social and Living Standard N'leasurenrenl
I:'
f
tr 15
tf
t"
1_
 Heallh Situation in Khakpu.

Figure 3.3 Ac cess lo lop wolerond flush toilel

!d in (hoirpur
63%

r Sindh

a Khairpur
rd

td

ty

tn
Access to tap walea - Access to flush toilet
ld
.l
n1

(e 3.9. Dislodging Events

of
Khairpur has suffered from crjses over the past
few years. Natural disasters by creating additjonal
and unforeseen demands on resources, systems
and management squeeze space for actions
on
wel,-dellberaied h ea lth secior sirateg y.
D isiriot Kh airpu r was partia lty affecied
by the floods of 201 1 .
]d As a result ofthese floods, 1,311 square
kilomelers area ofthe district and 3g4,137 people
were
ny affected. Out of iotal 76 Union Councils in the
district, 38 union councils were affeoted. The
floods
n caused damage jn 2b7S villages and affected
ajl 8 TaJukas ofthe District Khairpu|rz.
r,
Crises like these fJoods take away planned
resources and human capjtalfrom ihe sectorand
assign
them 10 the emerge).rt needs. Syslematic
daia are not available to chart out the complete
impact of
fjoods on the hearth syslem ofthe province.
lt can be surmised thar crises of such magnitude
affecl
the secloral priorjlies adversely.

a Un ted Nalions Oflke for lhe

Coordrnarron of Humaniia.ian Affairs. pakistan
Ptal te. Aptlt2Aj2. Floods 2011 _ Khajrpur Oistrict

16