In 2011, Aga Khan University’s Division of Women and Child Health, the Pakistan Ministry of Health and UNICEF conducted a survey to assess the overall nutritional status of target groups, including pre-school children (six to 59 months), school-aged children (six to 11-years-old), women of childbearing age (15 to 49 years old) and elderly persons (50 years and above). The National Nutrition Survey (NNS) 2011 was conducted in all provinces of Pakistan including Gilgit-Baltistan (GB), Azad Jammu and Kashmir (AJK) and the Federally Administered Tribal Areas (FATA), and covered both rural and urban populations while sampling the target group for assessment. This was the first time a National Nutrition Survey provided provincial data with reference to nutritional indicators and their outcomes on the target group.
The startling results of the NNS 2011 exposed the bleak situation of nutritional status as the report indicates that 58 percent of households were food-insecure nationally while Sindh was the most food-insecure province, followed by Balochistan. A whopping 72 percent of families in Sindh and 63.5 percent in Balochistan faced food insecurity as per the results of this survey. Were not the figures alarming enough to raise concerns among the lawmakers, responsive institutions and other relevant stakeholders?
The subject survey report further established that, “Stunting; wasting and micronutrient malnutrition is endemic in Pakistan. These are caused by a combination of dietary deficiencies, poor maternal, child, health and nutrition, a high burden of morbidity and low micronutrient content in the soil, especially iodine and zinc. Most of these micronutrients have profound effects on immunity, growth, and mental development. They may underlie the high burden of morbidity and mortality among women and children in Pakistan. Increasing rates of chronic and acute malnutrition in the country are primarily due to poverty, high illiteracy rates among mothers and food insecurity. Such rates can also be attributed to inherent problems in infant feeding practices and lack of access to age-appropriate foods.”
Malnutrition is a global predicament with around 150 million malnourished children in the world, but it is momentous to mention that half of the world’s malnourished women and children are found in just three countries: Bangladesh, India and Pakistan.
Malnutrition is an acknowledged health problem in Pakistan and has a sizeable role in the country’s high child morbidity and mortality rates. It has a significant correlation with multiple infections, other diseases and health issues. It is currently creating a hostile environment for maternal and child survival, especially for the poorest of the poor. It is largely affecting poor women and children, religious minorities and other socially marginalised groups.
The major causes of malnutrition include poverty, gender disparity, high food prices, poor dietary practices and low agricultural productivity in addition to the socio-political causes of malnutrition. The recent example of deaths associated with malnourishment in Thar is indicative of a community at risk due to lack of health-related services and all other factors mentioned above. Also, the level of getting affected by this misery may vary from community to community, i.e. certain households or individuals may be at even higher risk due to differences in income levels, access to land or levels of education. It can also be a consequence of health issues like diarrhoea or other infections due to decreased nutrient absorption. A lack of adequate breastfeeding leads to malnutrition in infants and children. Inadequate breastfeeding is the result of both lack of awareness and malnourished mothers who do not have sufficient milk to fulfil the nutritional needs of their children.
There are a number of potential disruptions to the global food supply chain that could cause widespread malnutrition. Climate change, increased incidents of natural and manmade disasters and deteriorating social and political circumstances are all future threats to food security and, consequently, they increase the number of those in the malnourished population. This will have significant socio-political and economic implications as well in addition to health-related consequences.
Malnourished children begin to fall behind their standard physical and mental development at around six months of age. Malnourished children experience developmental delays, weight loss and illness as a result of insufficient ingestion of proteins, calories and other nutrients, and are exposed to a variety of risks and complications. Poor access and quality of food, inadequate healthcare facilities, limited access to safe drinking water and sanitation facilities add to the gravity of the problem. The negative implications also include a weak immune system, impaired intellectual capabilities, increased vulnerability to infections and weak physique. The intellectual and cognitive impacts can be as far reaching as attention deficit disorder, impaired school performance, decreased IQ scores, memory deficiency, learning disabilities, reduced social skills, reduced language development and reduced problem-solving abilities.
Efforts to bring modern agricultural techniques such as nitrogen fertilisers and pesticides can result in a decrease in food insecurity and increased access and affordability to food consumables. Breastfeeding education and counselling also helps mothers in the long run. Breastfeeding in the first two years and exclusive breastfeeding in the first six months could save 1.3 million children’s lives globally. Nutritional education is an effective and workable model in a higher education setting. More ‘engaged’ learning models that encompass nutrition is an idea that is picking up steam on all levels of the learning cycle.
Other measures may include an improved public distribution system, increased purchasing power, price control, policy frameworks to resolve access to food issues, improvement in livestock, agriculture and fisheries systems, improved access to water, sanitation and health facilities, mobilisation of political will, awareness raising among stakeholders and sufficient efforts to ensure the right to food for everyone.
The issue is complex but there are tangible solutions, which depend on political will, responsive governance and economic innovation.
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