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4.4.1 Malaria
Malaria is a mosquito -borne infec tious disease caused by Plasmodium parasites, transmitted
through the bite of infected Anopheles mosquitoes.
Common symptoms include fever, chills, headache,
muscle pain, and fatigue, which can become severe if not
treated promptly. For the malaria incidence, 43 per 1000
cases of individuals in Pakistan experienced malaria in
2024–25, with a clear provincial variation. The lowest incidence is observed in Punjab with 12 per
1000 cases, while the highest in Sindh with 118 per 1000 cases, indicating a substantial regional
disparity. Malaria incidence remains significantly higher in rural areas with 49 percentage than in
urban areas with 34 per 1000 cases , reflecting persistent environmental and healthcare gaps
(Figure 4.6, Table 12 ). This trend suggests that southern provinces and rural communities
continue to face a greater malaria burden, largely due to climatic conditions, stagnant water, and
limited preventive measures.
4.4.2 Dengue Dengue is a viral infection transmitted by Aedes mosquitoes, characterized by high fever, severe headache, joint and muscle pain, and rash. It commonly spreads in densely populated and humid regions. Overall, 2 per 1000 cases of individuals in Pakistan suffered from dengue in 20 24–25, with the lowest incide nce recorded in Punjab with 1 per 1000 cases and the highest in Khyber Pakhtunkhwa with 5 per 1000 cases indicating notable regional variation. The incidence was relatively higher in urban areas with 4 per 1000 cases compared to rural areas with 2 per 1000 0 20 40 60 80 100 120 140 160 180 Pakistan Punjab Sindh KP Balochistan 34 10 74 31 5249 13 170 31 81 43 12 118 31 72 Urban Rural Total Figure 4.6: Malaria Cases Per 1000 Population 43 out of every 1,000 individuals in Pakistan is affected by Malaria
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cases, reflecting urban environmental conditions that favor mosquito breeding (Figure 4.7, Table 12). This trend suggests that urban centers remain more vulnerable due to poor waste management, stagnant water, and rapid urbanization, which continue to support dengue transmission.
4.4.3 Tuberculosis
Tuberculosis (TB) is a contagious bacterial infection caused by Mycobacterium tuberculosis,
primarily affecting the lungs and spreading through airborne
droplets. Common symptoms include persistent cough, fever, night
sweats, and weight loss. Overall, 3 per 1000 cases of households in
Pakistan had tuberculosis cases in 2024–25, with the lowest
incidence observed in Balochistan with 1 case per 1000 cases and
the highest in Sindh and Khyber Pakhtunkhwa with 4 per 1000
cases. The incidence was slightly higher in rural areas with 3 per
1000 cases compared to urban areas with 2 per 1000 cases ,
reflecting disparities in healthcare access and early detection. (Figure 4.8, Table 12) The trend
suggests that provincial differences remain modest, but rural populations continue to face greater
vulnerability due to limited diagnostic facilities and delayed treatment-seeking behavior.
Figure 4.7: Dengue Cases Per 1000 Population
0 1 2 3 4 5 6 7 8 9 10 Pakistan Punjab Sindh KP Balochistan 4 3 5 10 3 2 1 2 4 1 2 1 3 5 2 Urban Rural Total
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4.4.4 Hepatitis B
Hepatitis B is a serious viral infection that affects the liver and can lead to chronic disease,
cirrhosis, or liver cancer. It spreads primarily through contact with infected blood or body fluids,
often due to unsafe injections or unscreened transfusions. In 2024–25, Pakistan recorded an overall
incidence of 463 cases per 100,000 population, with the lowest rate in Balochistan with 272 cases
per 100,000 and the highest in Khyber Pakhtunkhwa with 671 cases per 100,000, showing
significant provincial variation. The incidence was higher in rural areas with 501 cases as
compared to urban areas with 402 cases per 100,000, reflecting gaps in healthcare access and
preventive practices (Figure 4.9, Table 12 ). The trend indicates that hepatitis B remains more
widespread in northern and rural regions, likely due to unsafe medical practices and limited
vaccination coverage.
Figure 4.8: Percentage of Tuberculosis Cases 0 1 1 2 2 3 3 4 4 Pakistan Punjab Sindh KP Balochistan 2 2 4 4 1 3 3 4 4 1 3 2 4 4 1 Urban Rural Total
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4.4.5 Hepatitis C
Table 12 indicates that overall prevalence of Hepatitis C in Pakistan stands at 599 cases per
100,000 population in 2024–25, with a
noticeably higher rate in rural areas with
684 cases as compared to urban areas
with 464 cases. This rural predominance
suggests disparities in healthcare access,
unsafe medical practices, and limited
awareness regarding infection control.
Among provinces, Punjab revealed the
highest incid ence with 77 8 cases
followed by Sindh with 45 1 cases,
Khyber Pakhtunkhwa with 354 cases , and Balochistan with 2 63 cases per 100,000 population .
(Figure 4.10, Table 12) This trend highlight the urgent need for improved screening, safe injection
practices, and public awareness campaigns, particularly in rural and underserved areas.
0
100
200
300
400
500
600
700
800
900
Pakistan Punjab Sindh KP Balochistan
402
281
528
867
352
501
422
662
637
236
463
364
590
671
272
Urban Rural Total
Figure 4.9: Percentage of Hepatitis B cases
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Child Mortality Rate
Child mortality rate (also known as the under -five mortality rate) is defined as:
“The probability of a child born in a specific year or period dying before reaching the age of five,
if subject to age -specific mortality rates of that period, expressed per 1,000 live births ”. It
encompasses Neo-natal Mortality Rate and Infant Mortality Rate.
4.5.1 Neonatal Mortality Rate
Neonatal mortality rate is defined as the probability of child dying before completion of
1st month after birth. The neonatal mortality rate has declined to 35 per 1,000 live births for period (2021–23) in HIES survey 2024–25, from 41 per 1,000 live births for period (2014 –16) in the previous round of HIES survey 2018–19.This reflects an approximately 15% reduction in neonatal deaths, indicating steady progress in new -born survival and maternal–child health interventions. (Table 13). 0 100 200 300 400 500 600 700 800 900 1000 Pakistan Punjab Sindh KP Balochistan 464 551 318 575 265 684 934 605 316 261 599 778 451 354 263 Urban Rural Total Figure 4.10: Percentage of Hepatitis C cases
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4.5.2 Infant Mortality Rate
Infant Mortality Rate (IMR) represents the probability of a child dying before reaching one year of age, expressed per 1,000 live births. It serves as a key indicator of a country’s overall health status and the effectiveness of its healthcare system, particularly in maternal and child health. IMR decreased to 47 per 1000 live births for the period of three years i.e. (2021-23) in HIES 2024-25, from 60 per 1000 live births for the period of three years i.e. (2014-16) in previous round of HIES 2018-19 survey. The decline in IMR from 60 to 47 deaths per 1,000 live births indicates a significant improvement in infant survival over the recent years. This positive trend reflects progress in healthcare delivery, immunization coverage, and maternal and neonatal care interventions across the country. Infant mortality rate for rural areas has shown considerable In Pakistan, 47 children per 1,000 live births, die before reaching their first birthday.
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decline to 50 per 1000 live births in 2024-25 as compared to 65 per 1000 live births in 2018-19 as well as urban areas has also shown decrease with 42 per 1000 live births in 2024 -25 from 48 per 1000 live births in 2018 -19.IMR in males and female s has declined, however decline is more pronounced in females as it decline to 40 per 1000 live births in 2024 -25 from 58 per 1000 live births in 2018-19. (Figure 4.11, Table 14).
Figure 4.11: Infant Mortality by Region and Sex 4.5.3 Impact of Maternal Education on Infant Mortality
The infant mortality rate in Pakistan shows an overall declining trend, indicating gradual
improvement in maternal and child health
over recent years. Despite this progress,
notable differences remain across
population groups, particularly when
education levels are considered. The
association between infant mortality and
mother’s education is presented in Table
3.15. As expected, infant mortality is
lower, 29 deaths per 1,000 live births
among children of educated mothers (class
11 or above), while it rises to 55 deaths per
0
10
20
30
40
50
60
70
Urban Rural Male Female Total
42
50
54
40
4748
65 62
58 60
2024-25 2018-19
Figure 4.12: Infant Mortality & Mother’s
Education
0
10
20
30
40
50
60 47
55
48 48
35
29
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1,000 live births among those whose mothers have no education. (Figure 4.12., Table 15) This highlights the strong link between maternal education and improved child survival outcomes . Strengthening girls’ education and ensuring women’s access to health informatio n can play a crucial role in sustaining this positive trend. Continued focus on female literacy and empowerment is therefore essential for reducing infant mortality further in the coming years. Pre-and Post-Natal Care
Maternal health continues to be a pressing concern in Pakistan, reflecting broader challenges faced by many developing countries. Despite notable progress in healthcare access and awareness, preventable maternal deaths still occur due to gaps in timely car e and inadequate management of pregnancy-related complications. Strengthening prenatal and postnatal services remains essential to ensuring safer pregnancies and deliveries. Improved monitoring of high-risk cases, enhanced training for healthcare providers , and increased community-level awareness can significantly reduce risks associated with conditions such as pre-eclampsia, anaemia, and infections. Sustained investment in maternal healthcare not only safeguards women’s health but also contributes to healthier families and stronger communities. Special emphasis has been placed on improving maternal health through the deployment of a large cadre of Lady Health Workers (LHWs). These workers conduct door-to- door visits to raise awareness about prenatal and po stnatal care, in addition to delivering other essential health services (World Health Organization) . Furthermore, a wide network of health houses has been established across both urban and rural areas, where trained Lady Health Workers provide guidance and support on maternal and child health, both before and after childbirth (UNICEF).
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4.6.1 Pre-Natal Consultation
Share of women who received consultation during their last pregnancy has improved notably
over time, as shown in (Table 16a). Pre-natal consultation increased from 84 percent in 2018 –
19 to 88 percent in 2024–25, highlighting positive momentum in maternal health awareness and
service outreach. This consistent growth underscores the continuing efforts to strengthen
maternal care services at the community level.
The pre -natal consultation rate remains substantially higher in urban areas with 94 percent
compared to rural areas with 8 5 percent .
However, rural regions have shown a notable
improvement of 5 percent points, increasing
from 80 percent in 2018–19 to 85 percent in
2024–25 ( Figure 4.13 ). This upward trend
indicates growing awareness and
accessibility of maternal health services in
rural communities, though a clear urban –
rural gap still persists. Across provinces,
Punjab continues to lead with 9 5 percent
coverage, followed by Sindh at 87 percent and Balochistan at 60 percent. Khyber Pakhtunkhwa
has demonstrated progress, rising from 74 percent in 2018–19 to 80 percent in 2024–25(Figure
4.14). In terms of health facilities, private clinics/hospitals with 49 percent and government
hospitals with 46 percent remain the most commonly visited sources for pre-natal consultations,
reflecting both the importance of private sector involvement and the continued reliance on public
health infrastructure in maternal care delivery. (Table 18).
0 50 100 150 200 250 300 Urban Rural Total 85 66 72 92 80 84 94 85 88 2013-14 2018-19 2024-25 Figure 4.13:Pre Natal-Consultation by Region
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4.6.1.1 Atleast Four Pre-Natal Consultation
Prenatal care is essential for ensuring the health of both mother and child. Access to regular
prenatal consultations helps in early
detection and management of potential
complications. overall 62 percent women
reported to have more than four pre natal
consultation. This percentage is observed
higher in urban areas with 73 percent
while rural areas with 56 percentage. It is
also observed that o nly 6 percent of
women had just one prenatal consultation,
while 3 2 percent attended two to three
visits, indicating most women receive more than a single check -up. (Table 1 7, Figure
4.15).
Figure 4.14:Pre-Natal Consultation by Province 0 20 40 60 80 100 Pakistan Punjab Sindh KP Balochistan 94 97 93 88 7985 94 81 78 52 88 95 87 80 60 Urban Rural Total Figure 4.15: At least Four Pre Natal Consultation 6 32 62 1 2-3 4 and Above
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4.6.2 Tetanus
Maternal and neonatal health remains a critical public health priority, as preventable causes continue to contribute to infant mortality in many developing regions. Among these, neonatal tetanus stands out as a significant threat to new born survival, primarily resulting from unsafe and unhygienic delivery practices. To address this, the administration of tetanus toxoid (TT) injections during pregnancy plays a vital preventive role. Two properly spaced doses of TT provide complete protection to both the mother and the new born, effectively reducing the risk of neonatal tetanus and improving overall maternal and child health outcomes. A total of five doses provide lifetime immunity, while women previously protected who conceive after ten years are recommended a single booster dose. Regular immunization campaigns and awareness programs are critical to sustain progress in eliminating neonatal tetanus. Ensuring access to skilled birth attendants and hygienic delivery practices further strengthens maternal and child protection. Table 16b presents Mothers who haves reported to receive a tetanus toxoid injection during their last pregnancy has increased to 86 percent in 2024-25 from 82 percent in 2018-19. This upward trend reflects improved maternal health awareness and wider coverage of immunization services, which is expected to contribute significantly to reducing the risk of neonatal tetanus and associated infant mortality. (Figure 4.16, Table 16b).
2018-19 0 50 100 82 90 77 75 53 86 94 85 81 49 2018-19 2024-25 Figure 4.16:Pregnant Women that received Tetanus toxoid Injection