Save the children

health

Malnutrition among women and children is a pressing problem all over the world including Pakistan. You! takes a look...

According to World Health Organization (WHO), “Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.” Furthermore, the condition has been defined by dividing it in to two broad groups. One is ‘under nutrition’ - which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). The other is overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and cancer). Despite a lot of hue and cry from healthcare professionals, malnutrition remains a major issue affecting mostly women and children in Pakistan.

Recently, Pakistan Scaling Up Nutrition (SUN) in collaboration with the United Nations World Food Programme (WFP) carried out a research on the impact of malnutrition in Pakistan. The magnitude of malnutrition in terms of mortality, morbidity, mental capacity and economic productivity has been dealt in details in this research. According to this study, more than 177,000 children die every year in Pakistan before their fifth birthday because they or their mother are malnourished. Moreover, National Nutrition Survey (NNS) report reveals that as many as 51 per cent pregnant women were anaemic, 46 per cent suffered from vitamin A deficiency, 47.6 per cent from zinc deficiency and 68.9 per cent from vitamin D deficiency. Malnutrition was only slightly lower among non-pregnant women - 50.4 per cent of whom were anaemic, 41.3 per cent had vitamin A deficiency, and 66.8 per cent had vitamin D deficiency. A remarkable 58.1 per cent of households are food insecure and only 3 per cent of children receive a diet that meets the minimum standards of dietary diversity.

The study also shows that nutrient deficiencies affects over 35-39 per cent of adolescent married women, while the problems only increased with age. Major reasons for high maternal mortality are malnutrition, severe anaemia, poor access to prenatal care (28 per cent) and dearth of trained attendants at birth (20 per cent).

Causes & Impact

According to Karachi-based obstetrician, Tasnim Sadiq, poor income is not the only predictor of malnutrition. In Pakistan, there are underlying factors such as illiteracy, unawareness, gender discrimination, urban-rural differences in access, utilisation and quality of healthcare which also influence health of women and children. “Take Sindh’s Thar region as an example, the situation is worse and is taking toll on the lives of women and their children. Every month we hear of children’s deaths due to malnutrition in the area. Malnutrition leads to dire consequences: it weakens women’s ability to survive childbirth, makes them more susceptible to infections, and leaves them with fewer reserves to recover from illness. That’s why the ratio of maternal mortality rate is very high in rural areas,” she reveals.

According to another expert, Dr Aalia Imam, maternal malnutrition increases the risk of poor pregnancy outcomes including obstructed labour, premature or low-birth-weight babies and postpartum haemorrhage. Severe anaemia during pregnancy is linked to increased mortality at labour. Malnourished mothers give birth to children with extremely low-birth-weight which is a significant contributor to infant mortality. Moreover, low birth-weight babies who survive are likely to suffer growth retardation and illness throughout their life. Growth-retarded adult women are likely to carry on the vicious cycle of malnutrition by giving birth to low birth-weight babies.

What can be done?

Target the vulnerable: Pregnant, lactating women and young children under three years are most vulnerable to malnutrition. Unfortunately, beyond the age of 2-3 years, the effects of chronic malnutrition are irreversible. This means that to break the intergenerational transmission of poverty and malnutrition, children at risk must be reached during their first two years of life.

Don’t let it slide: Malnutrition can even be found in urban cities. For children with Vitamin A deficiency, it reduces immunity and increases the incidence and gravity of infectious diseases resulting in increased school absenteeism. The mental impairment caused by iodine deficiency is permanent and directly linked to productivity loss.

Treat them steadily: Severely malnourished children need to be fed and rehydrated with great care so can’t be given a normal diet straight away. They will usually need special care in a hospital. Once they’re well enough, they can gradually return to a normal diet and continue this at home. It’s important that treatment is monitored regularly to make sure it’s working. Regular weight and height measurements will be taken, with referral to specialist services if there’s no improvement.

Institutional support: Research writer and University Professor, Dr Monir Ahmed, says, “At the government level, there is a need to educate the masses about adverse impact of malnutrition on the health of women and children. These programmes should be launched at federal and provincial level to spread awareness especially rural areas. Also, the rulers need to abandon their opulent, monarch-like lifestyle, and instead focus all their energies and resources on elevating the condition of the underprivileged and downtrodden people by providing them basic necessities of life.”

Do as much as possible: While the state and NGOs are playing their own part, you can play yours too by doing what is within your means. Support families to manage underlying factors affecting a child’s nutritional intake or get them treatment for any medical conditions causing their malnutrition.