Malnutrition is rampant in Pakistan and causes a lot of disease and deaths among children. Four out of ten children under five years of age are stunted and 17.7 percent suffer from wasting. The double burden of malnutrition is becoming increasingly apparent, with almost one in three children found underweight (28.9 percent) alongside a high prevalence of overweight (9.5 percent) in the same age group. The prevalence of overweight children under five has almost doubled over seven years, increasing from 5 percent in 2011 to 9.5 percent in 2018.

This data comes from National Nutrition Survey 2018 conducted by the Ministry of National Health Services, Regulation and Coordination with the cooperation of the UNICEF (United Nations International Children’s Emergency Fund) Pakistan.

The survey indicates that the distribution patterns of malnutrition among boys and girls are similar, with boys being more affected than girls by all forms of malnutrition. Children living in rural areas suffer more from under nutrition low weight, stunting and wasting) than their peers in urban areas. Overweight affects children almost equally, irrespective of locality.

Malnutrition is a condition of imperfect and inexact nutrition. Theoretically a child can be over-nourished as well as undernourished. However, some scientists use under-nutrition and malnutrition synonymously. In most developing countries, including Pakistan, children and women are more vulnerable to malnutrition than others.

Over the last decade, Pakistan’s progress in dealing with child malnutrition has not been encouraging. The National Nutrition Survey (NNS) conducted in 2011 had shown an acute malnutrition (wasting) rate of 15.1 percent, higher than the 13 percent recorded in the previous survey in 2001. Disaggregate wasting rates in the urban and rural populations were 12.6 percent and 16.1 percent, respectively. Besides, the NNS 2011 showed that more than half of children under the age of five were anemic, and 39 percent of children were zinc deficient.

A healthy population is important not only for a good quality of life but also because it augments the quality of human capital and is a determinant of socioeconomic development of the country. Nutritionist Dr Hina Khan suggests that unhealthy practices, over- and undernutrition, are significant risk factors in the mounting ailment burden of the country. “The increasing number of health issues in Pakistan is alarming. The poorest and the most vulnerable members of the population cannot afford a sufficient and nutritious diet”, she tells The News on Sunday.

According to World Health Organisation (WHO) malnutrition, as well as other nutrition and health issues in Pakistan, are multi-faceted and complex. They can arise variously from a deficiency of micronutrients, protein and glucose, obesity/overweight and non-communicable diseases. Poor diet, low-quality foods, and low physical activity are also frequent contributing factors.

These issues are causing new types of diseases that are difficult to cure owing to a lack of resources, says Dr Khan.

According to the United Nations, nearly 45 percent of Pakistani children under 5 years of age are stunted, 32 percent are underweight and 15 percent suffer from acute malnutrition.

Stunting is a major problem in Pakistan which has 12 million children with low height for their age. The NNS 2018 shows that the prevalence of stunting between 1965 (48 percent) and 1994 (36.3 percent) but deteriorated from 2001 (41.6 percent) to 2011 (43.7 percent). In 2018, at 40.2 percent, it was still at a global critical level. The average annual reduction rate is estimated at 0.5 pecrent, too slow to significantly reduce the stunting rate in the country.

Since 1997, the prevalence of low weight for height among young children has been on the rise, from 8.6 percent in 1997 to 15.1 percent in 2011 and 17.7 percent in 2018. Despite improvements in other socioeconomic indicators, acute malnutrition remains in the emergency zone. This is the highest rate of wasting in Pakistan’s history. The prevalence of underweight among children under five years of age is high in all jurisdictions, from 19.2 percent in Islamabad (Capital Territory) to 41.3 percent in Sindh.

The study estimated the proportion of overweight children under five at 9.5 percent, twice the target set by the World Health Assembly. Its prevalence is highest in KP (18.7 percent) and Balochistan (16.7 percent), and lowest in Sindh (5.2 percent) and ICT (5.8 percent).

Micronutrient deficiencies in children under five years of age are very low. More than half of children are anemic. These children suffer from a deficiency of micronutrients like iron, zinc, vitamin A, and vitamin D. These are essential micronutrients for human metabolism and catalyse more than 100 enzymes, facilitate protein folding and help regulate gene expression.

According to USAID’s Food Assistance Fact Sheet (FAFS), in Pakistan, ongoing conflict between the government and militant groups, recurrent natural disasters—including drought and floods—and a lack of basic health and nutrition education complicate household access to food and livelihood opportunities.

UNICEF data has indicated that main causes of childhood malnutrition can be household food insecurity, inadequate care and unhealthy household environment and a lack of health care services.

Maternal malnutrition is the primary cause of mortality and morbidity in children, states nutritionist and healthcare practitioner Shazia Zahra. In underdeveloped countries like Pakistan, according to Zahra, there is very little attention on maternal nutrition. Nutritional status of mother is responsible for a healthy child. It needs to be evaluated to unmask the causes of maternal malnutrition in Pakistan.

“Malnutrition certainly disturbs general health of mother and child health, endurance, and a healthy development of a kid. The malnourishment may be on account of a lack of essential micro-nutrients, which include vitamins and minerals. Such a shortage prompts significant issues during incubation period in mother and stunting in children after pregnancy”, she adds.

Women are often responsible for producing and preparing food for the household, so their knowledge — or lack thereof — about nutrition can affect the health and nutritional status of the entire family.

In fact, malnutrition poses a variety of threats to women and the next generation. “Undoubtedly, addressing women’s malnutrition has a range of positive effects because healthy women can fulfill their multiple roles like ensuring their families’ nutrition, having healthy children, and thus help advance countries’ socioeconomic development”, Zahra states. It is really important to eradicate illiteracy in the society and equip women with valid information about complications linked to processed food and the health benefits of natural food products, she adds.

In addition, the government must pay attention to addressing all forms of malnutrition through establishing and evaluating nutrition and health policies and programmes with an aim to enhance the nutritional status, diets, and health of its population.

The author is a staff member. He can be reached at warraichshehryar@gmail.com