“Well fed people can enhance their dignity, their health and their learning capacity. Putting resources into social programs is not expenditure. It is investment”, Luiz Inácio Lula da Silva, former President of Brazil
Finally the federal government has launched the long awaited National Nutrition Survey (NNS) 2011 in Islamabad in a high level ceremony where both the Federal Minister for Planning and Development and the Minister of State for Health Services Regulations and Coordination with the respective secretaries, representatives of the Provincial Governments and the Planning Commission of Pakistan, Donors, UN Agencies and civil society were present.
Findings of the NNS 2011 are depressing and clearly depicts how neglected the subject is in Pakistan. There has been no improvement in nutrition indicators for the last almost 4 decades and Minister Ahsan Iqbal rightly lamented the fact that the last decade following NNS 2001 has been totally lost as no tangible steps have been taken to improve the situation.
The NNS 2011 was the largest nutrition survey in the history of Pakistan conducted by the Agha Khan University’s Division of Women and Child Health, Ministry of Health and UNICEF with the financial support of AusAID and DFID. The NNS 2011 covered all provinces, Azad Jammu and Kashmir (AJK), Gilgit Baltistan and the Federally Administered Tribal Areas (FATA). This included 1,500 enumeration bocks (EBs)/villages and 30,000 households with a 49% urban and 51% rural distribution.
Results from the NNS 2011 indicated little change over the last decade in terms of core maternal and childhood nutrition indicators. With regard to micronutrient deficiencies, while iodine status had improved nationally, vitamin A status has had deteriorated and there had been little or no improvement in other indicators linked to micronutrient deficiencies.
The NNS 2011 revealed that the nutritional status has not changed much over the past decade. The anthropometry measurement of children under 5 revealed that 43.7% were stunted (too short for her/his age/low height for age) in 2011 as compared to 41.6% in 2001 NNS. Similarly, 15.1% children were wasted (weight that is too low for her/his height) compared to 14.3% in 2001. As per World Health Organization’s standards, a national average of 15% or above is labelled as an “EMERGENCY”.
The NNS 2011 indicates that stunting, wasting and micronutrient deficiencies are endemic in Pakistan. These are caused by a combination of dietary deficiencies; poor maternal and child health; 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 underline the high burden of morbidity and mortality among women and children in Pakistan.
Malnutrition plays a substantial role in Pakistan’s high child morbidity and mortality rates. Due to its correlation with infections, malnutrition in Pakistan currently threatens maternal and child survival and an estimated 35% of all under 5 deaths in the country are linked with malnutrition. It is imperative to respond to the situation if Pakistan has to be on track to achieve Millennium Development Goal (MDG) 4; about two third reduction in under 5 mortality.
More than 1.5 million children in Pakistan are currently suffering from acute malnutrition, making them susceptible to infectious diseases which may even lead to death. Long-term (chronic) malnutrition undermines both physical and mental development; nearly half of Pakistan’s children are chronically malnourished, and have their brain development and immune systems impaired, with life-long consequences.
Most of the irreversible damage due to malnutrition happens during conception and in the first 24 months of life meaning that risk begins from the day of conception to up to two years of age also referred to as the first 1000 days.
“Addressing malnutrition is one of the best investments Pakistan can make in its future”. There is a need to provide primary attention to nutrition-specific evidence-based interventions focused both on women and young children, while also addressing key malnutrition determinants.
It was encouraging to listen to the federal Minister for Planning and Development Ahsan Iqbal, during the launch of the NNS 2011, who was very clear that it is time for retrospection and that the issue is not going to be resolved through routine approach and all the stakeholders should respond to the situation as an emergency.
Besides, the launch of the NNS 2011 another positive development is Pakistan’s joining of the Scaling Up Nutrition (SUN) initiative at the global level in April 2013. More than 40 countries have joined the SUN Movement so far Pakistan being the largest country. SUN is an opportunity which the government should utilize effectively and gear up to improve the situation of nutrition in the country. Key donors, UN Agencies, National and International NGOs are there to support the federal and provincial governments to scale up efforts for nutrition in a coordinated and efficient manner.
There is a need for multi-sectoral interventions to address malnutrition involving health, education, social protection, water and sanitation, agriculture and private sector with a high level commitment from leadership to plan and implement multi-sectoral interventions.
Recently during the launch of the Lancet Series on Maternal and Child Nutrition 2013 in Pakistan, prominent nutrition expert and lead researcher of the NNS 2011 Professor Dr. Zulfiqar A. Bhutta said that the NNS 2011 underscores the primacy of addressing maternal and child under-nutrition at scale through targeted effective interventions; the current coverage rates for many key interventions remain poor and must be prioritized for scaling up. A broad multi-sectoral concerted approach is needed with political ownership of the problem and its determinants at the highest level said Dr. Bhutta. He further stated that there is a need to focus on Infant and Young Child Feeding strategies, Exclusive Breastfeeding promotion and complementary feeding, an area that has received scant attention to so far.
Given the success of salt iodization in reducing deficiency, greater attention must be focused on large scale fortification strategies for staples and common commodities/weaning foods, including home fortification recommended Dr. Bhutta and said that there are clear opportunities for linking the current cash support program and social safety nets to key nutrition interventions targeting women and children (hence addressing food insecurity).
It is also imperative to support women and their families to practice optimal breastfeeding and ensure timely and adequate complementary feeding. Breast milk fulfills all nutritional needs of infants up to six months of age, boosts their immunity, and reduces exposure to infections. There is also a need for steps by the federal and provincial governments for the implementation of the respective breastfeeding laws i.e. the Sindh Protection and Promotion of Breastfeeding and Child Nutrition Act 2013for effectively monitoring the unnecessary promotion of breast milk substitutes. The rules of the 2013 Act require to be notified immediately and an Infant Feeding Board established and notified to ensure implementation of the law. Similarly, effective steps for the implementation of the Protection of Breastfeeding and Young Child Nutrition Ordinance 2002should be taken at the federal level.
The writer is Director Advocacy and Child Rights Governance, Save the Children Pakistan Country Programme and tweets @amahmood72
This blog was also published at
http://everyone.savethechildren.net/articles/malnutrition-pakistan-crisis-long-overlooked and also appeared as an Op-Ed in The News on Sunday on October 06, 2013 http://jang.com.pk/thenews/oct2013-weekly/nos-06-10-2013/pol1.htm#5