Nutrition situation in Pakistan and a way forward
IN Pakistan, four out of ten children are stunted (Chronic malnutrition) and 17.7% suffer from wasting (Acute malnutrition).
Pakistani children and women suffer from triple burden of malnutrition with 29% children being underweight and 9.5 % overweight. 14.4% women are underweight 13.8% are obese, and at the same time the young girls and boys suffer from under-nutrition with 21% (boys) and 12% (girls) underweight and 11% overweight.
The National Nutrition Survey (NNS), 2018 revealed high rates of micronutrient deficiencies among children and women with 54% children being anaemic, 52% Vitamin A and 62 % Vitamin D deficient.
Similarly, 42% mothers are anaemic, while 27% suffer from Vitamin A and 80% from Vitamin D deficiency. Unfortunately, there has been little improvement in the situation over the past decades.
The little progress that has been made in addressing under-nutrition is still insufficient for the country to accelerate the human capital development required for its socio-economic growth and to ensure that the country meets the Sustainable Development Goals (SDG).
Reasons for slow progress, among others, include inadequate funding for nutrition sector and poor optimization of resource allocation to various nutrition interventions.
Over half of the households (63.1%) were found to be food secure, more so in urban (68.2%) areas than rural (60.0%).
Households experiencing a severe grade of food insecurity were 18.3%. About 17.7% children nationally suffered from wasting, with a higher percentage in rural (18.6%) compared to urban (16.2%) strata. Boys (18.4%) were more likely to suffer from wasting than girls (17.0%).
Wasting rates have increased from the previous two editions of NNS in 2001 (13.1%) and 2011 (15.1%).
In addition to high levels of stunting, wasting and micronutrient malnutrition, Pakistan has also begun to see a substantial burden of overweight and obesity, thus creating a triple burden of malnutrition.
This is caused by a combination of dietary deficiencies, poor maternal and child health, high burden of morbidity, and low micronutrient content in the soil, especially iodine and zinc.
Stunting, wasting and micronutrients deficiencies have profound effects on immunity, growth, and mental development of children.
Furthermore, the high rates of malnutrition and micronutrient deficiencies among women of reproductive age point to a vicious cycle of malnutrition which may underline the high burden of morbidity and mortality among women and children (both boys and girls) in Pakistan and could also contribute to high risk of non-communicable diseases in the future.
Despite no federal funding and no PC1 for Federal Nutrition Program so far, the Nutrition Wing, Ministry of NHSR&C, in collaboration with Provincial Departments of Health, UN Agencies, NGOs and partners has continued to respond with effective interventions for the prevention and treatment of malnutrition among the most vulnerable segments of the population especially women and children.
These interventions for improving the nutritional status of the population focus on prevention of stunting, Infant Young Child Feeding (IYCF), nutrition counselling, breast feeding promotion and protection, food fortification and community management of acute malnutrition. Some of recommendations for improvement include:
1. The M/o NHSRC being the responsible entity for coordination and collaboration with all provinces/ regions and the development partners may immediately consider to develop and deploy extensive human resources for nutrition at all levels from policymakers, implementers, supervisors, healthcare professionals and community workers.
These workers should have expertise and training in nutrition and work full time on nutrition activities.
2. There are significant nutritional needs for women of reproductive age in Pakistan, and some of the associations with maternal height reflect intergenerational problems, while others reflect more acute exposures during pregnancy.
Targeting women nutrition way before pregnancy and during adolescence and preconception care provides a window of opportunity, which can bear enduring results for generations to come.
Addressing foetal growth retardation and small for gestational age births, estimated to account for over a quarter of all births, may also reduce the burden of stunting in young infants and improve developmental outcomes.
3. Improving nutrition will require food security and social protection. Pakistan has cash transfer programs through EHSAS, social welfare and Pakistan Bait-ul-Maal funds, and these transfers can be conditionally linked to health and nutrition services, with upward revision in cash transfer amounts to adjust for food inflation and linkage of beneficiaries with livestock and agriculture schemes.
4. Pakistan must do better to improve rates of exclusive breastfeeding. This requires mass awareness and stringent implementation of the ‘International Code of Marketing of Breast-milk Substitutes’.
Additionally, support structures for working mothers to continue breastfeeding must be provided including paid maternity leave beyond the current limitations, availability of child care centres and designated area for breastfeeding at work place as well as support for women working in the non-formal sectors.
5. Beyond breastfeeding, Pakistan has never had a concerted programme to improve complementary feeding, which is a major determinant of linear growth deviation after 6?months of age. The current focus and guidelines on complementary feeding are particularly poor.
Interventions are needed to optimize the timing of introduction of complementary foods, with appropriate low-cost fortified foods in high-risk food insecure households or appropriate home available diets/recipes in food secure households, consideration should be given to the provision of low-cost commodities for complementary feeding.
6. A comprehensive and a massive national campaign must be launched to disseminate accurate health/ nutrition messages, and to improve environmental and living conditions, promote the use of toilets and reduce the risks of fecal contamination.
Based on these recommendations and as per directions and guidance of National Health Task Force, chaired by PM, a comprehensive PC1 for stunting prevention has been developed by the Nutrition Wing.
The objective is “To significantly reduce malnutrition related stunting in Pakistani children in the next 5 years, and virtually eliminate it in children born in 2026”.
It is important to mention here that the EHSAS Nashwonuma Program, recently launched in 15 districts of the country would be integrated with the National Nutrition program in the common districts and it would contribute positively in the overall goal of elimination of stunting from Pakistan.
However dire the situation of nutrition in Pakistan is, it is definitely ripe for change with a greater current emphasis on nutrition and formulation of various national and provincial nutrition focused strategies; policy makers and planners need to recognize the importance of improved child health and nutrition for national development and look at nutrition strategies as a net investment in the nation’s future.
—The writer is Director Regulations & National Nutrition Programme, M/o National Health Services, Govt of Pakistan.