Continuation of nutrition services amid Covid-19

COVID-19 has aggravated the already precarious situation of malnutrition and food insecurity

As the World Breastfeeding Week (August 1-7, 2020) was commemorated recently, we must remind ourselves that breastfeeding is the single most cost-effective way to protect maternal and young child health, promote healthy growth, and ensure the best start in life and optimum development in the early years of life. Breast milk provides the ideal nutrition for infants. It has a nearly perfect mix of nutrients — everything that a baby needs to grow. Breast milk helps babies fight off viruses and bacteria during her/his initial days.

The Covid-19 pandemic has affected our lives in many ways and would continue to do so unless bold measures are taken to adjust to the new normal. Among many others, it has aggravated the already precarious situation of malnutrition and food insecurity faced by several developing nations including Pakistan.

In Pakistan, the first case of Covid-19 was detected in February 2020 and then the numbers escalated rapidly before the Government of Pakistan-led SOPs were introduced and adapted at the public level, though many remained in denial of even the existence of the virus.

Emergency measures including partial lockdowns, complete lockdown of areas with high prevalence of the virus, an aggressive nationwide Risk Communication and Community Engagement campaign and emergency procurement and distribution of the personal protective equipment (PPE) to the frontline health workers have resulted in the recent decline in number of positive cases. However, lockdowns had a negative impact on the availability and public access to essential health and nutrition services in the country.

Even in the pre-pandemic period, Pakistan had been struggling with the grave situation of all forms of malnutrition. Millions of children, adolescents, pregnant and lactating women lacked adequate nutrition. As the National Nutrition Survey 2018 revealed that nearly 12 million children under five years of age are stunted, and about 2.5 million children are severely wasted.

It is estimated that only one out of 20 children consume the right quality and quantity of food. Nearly half of all women (42.7%) are suffering from anaemia and 14.4% of women are suffering from energy/caloric deficiency. The problem of being overweight and obesity have increased from 28% (2011) to 38% (2018) in the same group. More than half of Pakistani adolescent girls (56.6%) are anaemic. Besides high undernutrition rates, being overweight is emerging as a serious health hazard among young children and adolescents. It is projected that approximately four million adolescent girls are overweight.

A high prevalence of malnutrition is a major constraint to development. A study carried out by the Government of Pakistan in partnership with the World Food Programme in 2016, revealed that Pakistan is losing $7.6 billion (3% of GDP) due to malnutrition. It is also clear that in the absence of adequate nutrition services, gains made in terms of under-five child mortality will quickly be compromised as a child severely wasted is eight to nine times more at risk of mortality than his well-nourished peer.

A recent Lancet publication indicated that wasting will be a major cause of increased mortality in the Covid-19 context (between 18% to 23%) in a country where the health system is stretched by the response to the pandemic.

Government measures to prevent and control the spread of Covid-19 had a profound effect on the access to nutrition services. Partial lockdowns led to the disruption of essential health and nutrition services for mothers, newborns, children, and adolescents, as some health facilities were temporarily closed. Absenteeism of health service providers/community health workers is also observed, due to lack of transport and/or fear to get out of their residence. In addition to the constrained availability of nutrition services, reduced service uptake is also observed as the consequence of movement restriction. At the same time, temporary closure of non-essential businesses has had severe implications for nutrition and household food security, especially for the most vulnerable segments of society.

The already burdened public health system now faces an enormous challenge to curb the spread of the virus as well as to continue the provision of quality and equitable access to essential health and nutrition services. As a result, the disruption of essential services could result in worsening the nutrition situation of children and pregnant and lactating women, and outbreaks of measles, malaria, and tuberculosis to further exacerbate the overall health situation in Pakistan.

The provision of adequate nutrition during the pandemic is essential for people to enhance their immunity which in turn helps fight the infection. Conversely, a poor nutritional status is likely to weaken the immune system and increase susceptibility to the virus. Hence, there is a need to provide timely and quality preventive and curative nutrition services to children, adolescents and pregnant and lactating women.

As the country fights off the pandemic, Pakistan’s efforts to sustain essential nutrition services including a directive to ensure continuation of nutrition services along with the provision of guidelines and key nutrition messages issued by the federal Ministry of National Health Services, Regulations and Coordination to all provincial governments and partners, is highly commendable.

With a steady decrease in number of Covid-19 cases, the situation is slowly returning to a new normal where people may have to adapt to wearing a mask, maintaining social distancing, washing hands frequently with soap or using appropriate sanitiser, and self-isolation in case of having symptoms, as everyday practices.

Pakistan’s development partners including UNICEF, WHO, UNAIDS, UNFPA, and the World Bank are making all efforts to help the country resume and maintain essential nutrition services in order to save lives threatened by various forms of malnutrition and the coronavirus itself.

Published in The Express Tribune, August 8^th, 2020.

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