Demographic change in a rural mountainous village in northern Pakistan, from 1989-2012

Background: Oshikhandass, a rural village in the Karakorum mountains, was studied from 1989-1996 and 2011-2013. Objective: To understand changes over 24 years in demography, water and sanitation in a typical village in Gilgit-Baltistan. Methods: Female health workers trained and supervised by Lady Health Visitors, doctors and sociologists surveyed all village households for demographic, water and sanitation data. Results: Population doubled from 3,624 in 1989 to 7,157 in 2011. Average household size declined from 11.8 to 8.3. From 1989-1996, 1,100 children were born, 748 individuals migrated in, and 304 migrated out. Since 1996, 214 families, 24% of the population, migrated in. From 1989-1996, average age at death was 25.2 years (0 days to 108 years); 57% of deaths were in children under age 5, of which 76% were infants. In the first study year, birth rate was 35.3 per 1,000 and under-5 mortality rate was 26.5 per 1,000. In 1989, all drank untreated glacier water stored in shallow pits (82%), from open channels (13%) or tanks (5%). Four percent used flush toilets and 80% traditional pit latrines (chukans). In 2011, 24% used filtration plant-treated water and 76% channel water; 63% used flush toilets and 37% chukans. Fuel usage was unchanged with 95% using wood. Conclusion: Rapid population growth and in-migration occurred over 24 years. Water use was primarily from glacial channels with introduction of filtration plants. Use of flush toilets increased significantly. Biomass fuel use for cooking and heating persisted. Changes in rates of childhood disease are under investigation.