“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
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