According to the National Nutrition Survey 2011, more than half of Pakistan’s women and two-thirds of its children suffer micronutrient deficiency.
The widespread deficiency of vitamins A and D, zinc, folic acid and iron represents a severe public health issue that has significant impacts on morbidity and mortality. Micronutrient deficiency is evidently linked to the slow physical and cognitive growth in infants and children; diminished learning capacity and school performance among students; and lower productivity and earning among adults.
A recent analysis found that among the consequences that have emerged from the current prevalence of malnutrition, including micronutrient deficiency, is the national economic loss of $3.5 billion annually – three percent of the GDP. More than a quarter of this financial burden emerges from the nutrition deficiency faced by women and children in the first 1,000 days, which begin from the time the baby is conceived till it reaches 24 months of age. These days are significant in the life of a child as any nutrition deficiency during this time can lead to irreversible effects. Hence, it is imperative to meet the nutrient requirements during these early days of pregnancy and childhood.
Even in adulthood, this hidden hunger occurs when the quality of food people eat does not meet their nutrient requirements. The food is deficient in micronutrients and compromises a person’s health. This human and economic burden of micronutrient deficiencies can be significantly avoided through nutrition supplementation, nutrition education and food fortification
Food fortification is the simplest and most cost-effective way of addressing micronutrient deficiency. It entails adding vitamins and minerals in our routine food, like salt, milk, wheat flour and cooking oil. Various studies have reported success stories wherein micronutrient deficiencies were overcome with the simple process of food fortification. A national programme in Costa Rica reduced anaemia and iron deficiency in children by 70 to 80 percent thorough this process.
Similarly, the intake of iron or folic acid fortification during pregnancy – or even before it – has significantly reduced birth defects globally. The Copenhagen Consensus Conference (2008) declared that in combating malnutrition in undernourished children, the specific provision of vitamin A and zinc delivered the most beneficial results. Moreover, micronutrient fortification of iron and iodine is highly significant and reaps even higher dividends than critical interventions like the expanded immunisation coverage for children.
Pakistan is an agro-based country and produces enough food that can meet the consumption requirements of the population. It has all the potential to achieve high levels of economic growth and human development. But despite the decent production of food, micronutrition deficiency exists at a massive scale.
In the current context, there is a desperate need to provide awareness at all levels – including policy, institutional and community – to ensure provision and benefits of fortified food. A comprehensive food fortification policy is needed to address the issue of stunted growth in children and overcome micronutrient deficiencies. Mandatory standards and legislation should be introduced to support the food fortification process, example salt iodisation, fortification of oil with Vitamin A, milk with Vitamin D and wheat flour with iron and folic acid etc. Various interventions, such as the provision of premix or other required products at subsidised rates to mills to promote food fortification, or incentivising the food industry for being innovative and technologically advanced, can ensure provision and availability of fortified food in the market.
Food fortification is a multi-sector initiative and requires the participation of various government agencies, the private sector, the media and academia, to develop an environment for its implementation. Different stakeholders should actively play their part in the implementation of this intervention. For example, at the industrial level, training programmes should be conducted to define fortification and enhance the capacity to link fortified food with nutrition and health outcomes.
Moreover, the academia should be engaged so as to undertake special researches to identify and inform about the requirements and challenges involved in the implementation of the programme. The mainstream media, both electronic and print, and social media should also play their part in educating people.
Pakistan is signatory to the Sustainable Development Goals (SDGs), and among the 17 goals, SDG2 targets bringing the rate of hunger down to zero. In order to achieve this goal, there is a need to prioritise strategies that can end hunger; such as access to food, improvement of nutrition intake, strengthening food producers and making food production systems sustainable.
There is a need to ensure that women and children consume sufficient amounts of key vitamins and minerals. This can be achieved cost-effectively, by adopting preventive measures and following proven strategies of food fortification which can substantially reduce child mortality and nutrition-related problems. A legislation regarding food fortification would definitely help in ensuring that the population gets the necessary vitamins and minerals it needs to survive.
The writer is a public health consultant.