Pakistan’s malnutrition crisis

Published: April 7, 2018
The writer is a consultant dietician at National Hospital & Medical Centre, Lahore

The writer is a consultant dietician at National Hospital & Medical Centre, Lahore

Some 58% of households in Pakistan are food insecure out of which 9.8% are food insecure with hunger, according to the National Nutrition Survey 2011. Over the past few years, malnutrition has emerged as one of the world’s leading challenges with regard to food security. It should come as no surprise that the menace of malnutrition is especially prevalent in Pakistan, given the poor socioeconomic conditions.

Undernutrition, simply put, is a condition in which our bodies are deprived of all the necessary nutrients, which can only be addressed through a balanced diet. Our diets in Pakistan are barely what we can classify as ‘balanced diets’. This is an issue that arises directly as a result of food insecurity. Food insecurity is one of the greatest challenges faced by Pakistan, according to the Food Security and Nutrition Strategic Review for Pakistan in 2017. The overall prevalence of undernourishment is estimated to be about 18% of the entire population.

The high percentage of food insecurity poses a direct threat to our nation and has resulted in a number of detrimental health-related issues, women and children under the age of five being the major sufferers. The health risks associated with malnutrition are morbidity and infections which lead to mortality. The three major hits that we are facing as a nation are stunted growths in children, anaemia in women who are of reproductive age and obesity in adults.

The National Nutrition Survey 2011 sheds light on some disturbing statistics: 1/3rd of Pakistani children are underweight and iron deficient, 15% are wasted and 14% women are either thin or wasted. Certain deficiencies can be boiled down to the absence of three essential micronutrients: vitamin A, zinc and iron. However, what we fail to understand is that the major source for such essential micronutrients is itself often deficient in them.

Maize, a highly profitable crop that has a yield two times higher than other cereal crops, is deficient in zinc, according to Dr Tahir of the University of Agriculture, Faisalabad. This deficiency in the crop can be attributed to deficiencies in soil and hence, it becomes imperative that governing bodies put in place policies which support investment in useful fertilisers.

Regulation of such policies will not just help Pakistan to turn over its current dreadful economic landscape, but will also help alleviate the epidemic of malnutrition that has been prevailing for decades and experiences a surge every year.

Pakistan was not able to meet its millennium development goals by 2015 and still hasn’t because a major chunk of the GDP, which is around 3%, gets dedicated to the malnutrition crisis. Economist Yunus Kamran advocates that better nutrition enhances economic growth, but also argues that Pakistan needs strong economic theories and models to formalise this relationship. The disparity in the nutritional status between the urban and rural divide is much less and varies widely across the country. Forty to 50% of the periodic seasonal food insecurity reported is from regions like Balochistan, Sindh, South Punjab, parts of Khyber-Pakhutunkhwa and Fata. The food insecurity seen in these regions is an inherent cause of poor and unhygienic living conditions, with little access to safe drinking water and no access to adequate sanitation facilities. This when compounded with poor access to healthcare facilities makes the situation pretty gruesome.

With malnutrition so widely prevalent with a high economic cost, Pakistan ranks below its neighbours like China, India and Bangladesh, according to international donor services. This is also supported by a report prepared by the United Nations Children’s Fund and the World Health Organisation, which highlights how the prevalence of stunting — a reported consequence of malnutrition — has dropped considerably in India, China and Bangladesh, except Pakistan where the issue has been exacerbated. Stunting isn’t alone in marking such a trend. Anaemia and obesity are following the trail, begging for an urgent action to be taken. But the lack of political will and the leadership is delaying this call for action as the last National Nutrition Survey (NNS) was done back in 2011 under the nutritional information system.

Although the NNS of 2011 resulted in a major rethink of the nutritional services in the Pakistan Integrated Nutrition Strategy — the endorsement of national breastfeeding standards and other projects like the incorporation of nutrition studies in university curriculum, acknowledging food fortification as one way to address the existing micronutrient deficiencies, training workshops for healthcare workers and integration of vital services for children and women — almost nothing has changed. There have been reports that the government is soon going to carry out another NNS and that is a welcome news. However, we must not be surprised if the indicators have grown worse because the government still hasn’t implemented a multi-sectoral nutrition strategy.

The previous research outlines many underlying factors actively participating in contributing towards the issue of malnutrition. These include poverty, low literacy rate, lack of decision-making power given to women, inadequate living conditions and poor access to healthcare facilities, but fail to address and identify the reason behind greater disparity observed in province-wise profiles of the country. It also falls short in establishing a clear relationship between poverty, under-nutrition and economic growth.

Undoubtedly, fresh research, along with perhaps a new approach, is required to holistically inquire about and address the issue of malnutrition still prevalent in Pakistan. However, until both federal and provincial governments take note and formulate a cohesive and coherent action plan for combating malnutrition, this scourge will continue to invade the lives of poor Pakistanis.

Published in The Express Tribune, April 7th, 2018.

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