Malnutrition: A hidden crisis in Pakistan

Malnutrition is the underlying cause of 35 per cent of under-5 deaths in Pakistan. It is considered one of the hidden crises. The stunning results from the recent National Nutrition Survey (NNS, 2011) show an alarming nutrition situation in Pakistan. Under-nutrition is one of the main causes of death among infants and young children. Those who survive have less learning capacity that reduces their productivity as adults, which impact negatively on the economy. At least 2% of GDP is lost every year on account of current levels of malnutrition in Pakistan. Addressing the problem would only cost a small fraction of that amount. Reversing adverse trends in nutrition needs appropriate policy direction, political commitment and a concerted effort from all sectors.

The main indicators of malnutrition include stunting, wasting and micronutrient deficiencies. Stunting is when a child is too short relative to her/his age. It is a form of “chronic” malnutrition, which is accumulated over long period of time. Stunting generally occurs before the age of two and is largely irreversible. According to Save the Children’s State of the World’s Mothers 2012 report, the period from the beginning of pregnancy to 24 months of age – the first 1000 days – are critical for nutrition – and the window to prevent malnutrition. The main causes of malnutrition include poor nutrition for mothers during pregnancy, too few calories, poor quality of food (e.g. micronutrients), repeated infections (e.g. diarrhoea, malaria), and poor feeding practices (e.g. not feeding colostrum). According to the findings of NNS 2011 43.7% of children under five are stunted in Pakistan.

Wasting is when a child’s weight is too low for her/his height. Wasting is usually the result of acute significant food shortage and/or severe disease. Children suffering from wasting, particularly in severe cases of wasting, are more likely to die. According to the findings of the NNS 2011, 15% of children under-five years in Pakistan are wasted. As per World Health Organization’s standards, a national average of 15% or above is labelled as an “EMERGENCY”.

The survey results also highlight micro-nutrient deficiencies including vitamin A, iron, zinc, iodine and vitamin D. It is clear now that malnutrition is not just a food problem or the result of displacements, floods or other emergencies. Malnutrition is a national calamity. It is indicative of the underlying issues the country is facing including poor infant feeding practices, poor sanitation and hygiene habits, increasing food insecurity and lack of awareness about child and maternal nutrition.

Traditionally nutrition has been viewed as a problem to be looked after only by the health sector - planning commission or Ministry of Health at the federal level and Department of Health at the provincial level. This narrow approach then excludes those remedies  which would cater to the wider economic and social contexts which predispose a community to poor nutrition. Major findings of the NNS 2011 clearly indicate the urgent need to address malnutrition through an integrated approach, which addresses immediate, underlying and basic causes of malnutrition. This is a challenge to mainstream nutrition and to ensure that all relevant departments and stakeholders are cognizant of their roles and have effective coordination.

There is now real evidence that most of our children are under-nourished in many ways … ways which affect the development of their brains in the first two years of life, with negative impact on their performance in or out of school and subsequently in their work productivity.

Devolution is an opportunity to scale up investment in health and nutrition after a long period of stagnation. It is high time that the provincial governments make specific budgetary allocations for nutrition programs. Social protection schemes (like Benazir Income Support Program and Pakistan Bait-ul-Maal ) allocate increased resources and have increased focus on nutrition outcomes.

According to Save the Children’s State of the World’s Mothers 2012 report, “In developing countries, breastfed children are at least 6 times more likely to survive in the early months of life than non-breastfed children”. It further states that “Breastfeeding is the single most effective nutrition intervention for saving lives”.

In Pakistan, we need to work hard both at the grassroots level for behavior change where health workers can play a crucial role. The provincial governments should adopt and take practical steps for the implementation of the Protection of Breastfeeding and Young Child Nutrition Ordinance 2002 and it’s 2010 rules to help prevent illegal promotion of formula milk and promote the importance of exclusive breastfeeding for the first six months of a child.

Keeping in view, Pakistan’s nutrition situation, it is time for Pakistan to join the Scaling up Nutrition (SUN) Movement like other regional countries such as Bangladesh and Nepal. This will help bring in technical and financial assistance for improving the nutrition situation in the country on a sustainable basis.

One does not need to be an expert to understand how important political commitment is to improve the nutrition situation in the country. With political commitment we can ensure not only strong leadership and the much desired coordination at the high level but also sustainable funding. High level coordination, strong leadership and funding can then result in comprehensive programs and cost effective interventions.

(The writer is a development practitioner and tweets @amahmood72)