Malnutrition among women and children is a pressing problem all over the world including Pakistan. What can be done to combat this pandemic? You! takes a look...
Malnutrition among women and children is a pressing problem all over the world including Pakistan. What can be done to combat this pandemic? 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). In the midst of adverse problems such as poverty, access to clean water and food, malnutrition is another major issue that affect mostly women and children. This week, You! highlights the problem and how several programmes have been working or currently being introduced in Pakistan to curb the issue of malnutrition among women and children belonging to the underdeveloped areas of the country. Read on...
The current scenario
All over the world, nearly half of the deaths (around 2.7 million) among children under five are due to malnutrition. This also leads to impaired growth and developmental outcomes apart from increased risk of morbidity and infections. Furthermore, 159 million children under the age of five are stunted with heights - less than the normal height for that age - and around 240 million children are at the risk of developmental impairment.
Women suffering from anaemia are also subjected to malnutrition, so the problem is not only confined to children and is also rampant among underprivileged women. These women, during their reproductive age, suffer from malnutrition as they usually are iron-deficient. Wasting (acute malnutrition) is another issue women from the lower strata of our society face during pregnancy. As a matter of fact, maternal malnutrition not only leads to increased risk of mortality among women but also contributes to foetal growth restriction (small size of the baby in the womb) that, in turn, multiplies the risk of growth faltering and stunting in childhood. The latter can cause long-term detrimental cognitive, motor and health impairments.
Malnutrition in Pakistan
Sadly, the problem is widespread among all ages. According to the National Nutrition Survey 2011, one-third of all children are underweight, nearly 44 per cent are stunted, 15 per cent are wasted, half of them are anaemic and almost one-third of these children have iron-deficiency anaemia. These rates have hardly changed over two decades according to the findings of a Maternal and Child Nutrition study published in The Lancet in 2013. Notable differences can be found between the nutritional indicators of urban and rural populations; children among the rural and urban poor are at greatest risk. Among women, 14 per cent in the reproductive age bracket are thin or wasted (with a body mass index less than 18.5 kg/m2) and this prevalence is highest among households that are food insecure. These differences in maternal and child malnutrition are also remarkable among various provinces and sub-regions, and clustered in areas widely recognised as high-risk districts. Sadly, the situation is more or less same in 2017-18.
Factors attributing to malnutrition
Despite a largely agrarian economy in Pakistan, many rural and urban families live below the poverty line. The most pervasive and dominant factor underlying maternal and child under-nutrition is widespread poverty and food insecurity. Many families cannot afford or access enough nutritious foods like fresh fruit and vegetables, legumes, meat and milk. Periodic or seasonal food insecurity is reported by almost 40-50 per cent of families in certain provinces, especially in Balochistan, Sindh, South Punjab and parts of Khyber Pakhtunkhwa and Fata. These are also compounded by poor and unhygienic living conditions, little access to safe water and adequate sanitation that exposes children to high rates of intestinal infections and diarrhoea. Recent data from a UNICEF progress report (2013-2015) on improving access to sanitation in Pakistan suggests that about 58 million people (36 per cent) either defecate in the open or have access to shared toilets. In rural areas, 45 per cent of the population still practice open defecation.
What can be done?
In April 2016, the United Nations General Assembly adopted a resolution proclaiming the UN Decade of Action on Nutrition from 2016 to 2025. The Decade aims to catalyse policy commitments that result in measurable action to address all forms of malnutrition. The aim is to ensure all people have access to healthier and more sustainable diets to eradicate all forms of malnutrition worldwide. Also, UNICEF is helping to overcome this persistent problem by identifying malnourished children and women, especially in hard-to-reach, marginalised communities, and raising their nutrition levels through systematic interventions.
One such case is of Haseena Fiyyaz from Muzaffargarh (Southern Punjab). One day she walked into UNICEF’s Mehmood Kot Basic Health Unit (BHU), based in Muzaffargarh, with her 10-month-old boy, Younas, in her arms. One could easily see that not only was the child frail and underweight, but so was the mother.
Once Sumaira, the Lady Health worker there, had performed the Mid Upper Arm Circumference (MUAC) check on Younas and measured his weight and length, it became evident that he was suffering from Severe Acute Malnutrition (SAM). She registered Younas in the Outpatient Therapeutic Programme (OTP), which is part of the Community Management of Acute Malnutrition (CMAM) programme. Sumaira handed Ready-to-Use Therapeutic Food (RUTF used internationally to treat malnourished children) sachets to Haseena and explained that Younas should be given them every day. She also advised her to attend the health, hygiene and nutrition sessions that are conducted in both the BHU and the community to help women understand the significance of breastfeeding, maintaining good hygiene and a nutritious diet. Haseena left with a two week supply of RUTF, knowing she could collect more as she needed.
Seven weeks later, after doing a follow-up check on Younas, Sumaira was delighted to see that his MUAC measurement had improved from 10.5 to 11.5 centimetres, and his weight had increased from 5.7 to 6.6 kg. Overall, his nutritional status had improved from SAM to Moderately Acute Malnutrition (MAM).
Keeping the situation in mind, several programmes have been induced or are in the pipeline to curb the nuisance of lack of nutrition among women and children in Pakistan...
Behaviour Change Mass Media Campaign
This campaign, by Nutrition Support Programme, Health Department Government of Sindh, has been introduced recently. NSP is working in nine different districts such as Badin, Tharparkar, Umerkot, Tando Muhammad Khan, Sangarh, Larkana Kashmore, Kambar Shahdad Kot and Jacobabad. It aims to reduce the prevalence of anaemia in women of reproductive age from 60 per cent to 50 per cent in three years, as well as lower the percentage of wasting to 30 per cent in three years, and stunting 0.1 per cent per year among children under five. These figures would be achieved by community and facility-based interventions coupled with mass media behaviour change communication in local and national languages through short documentaries, dramas, TVCs, anthems, feature films and many other creative angels.
Brand ambassador NSP, Sana Bucha, while talking to You! explains, “As this problem leads to so many other problems (early marriages and no interval between kids), it is extremely important to first educate people what nutrition they require to stay healthy. They are so unaware that if the government installs water plants to provide them with clean water, they think it will make women infertile. I have been to those places and the situation is horrible. So, it is high time that we start making efforts and work for our people and their well being.”
Food Fortification Programme
As The Guardian reports, a new initiative of fortification of everyday foods such as bread and oil is being rolled out in Pakistan in an attempt to tackle chronic and widespread malnutrition.
The food fortification programme, which is backed with $48 million (£36 million) of funding from the UK’s Department for International Development (DfID), will see nutrients added directly to wheat flour, edible oils and ghee at source in mills and factories.
The leading partner of the programme and a health policy adviser at Mott MacDonald, Lucy Palmer says, “This is the first time that they will be fortifying a staple food in Pakistan across the whole country. It is a mass-scale intervention. The programme is aimed mainly at changing the health of women and children. Palmer says this is because of the disastrous long-term impact of poor health in mothers. “Stunting is inter-generational. If you are poor and your mother is stunted, it could take a few generations to iron out, which perpetuates inequalities.”
Integrated Reproductive Maternal Neonatal Child Health and Nutrition (IRMNCH&N)
The Department of Health, Government of Punjab has launched an Integrated Reproductive Maternal Neonatal Child Health and Nutrition (IRMNCH&N) Programme. The Nutrition component of the programme is supported by UNICEF. It includes screening of children and pregnant and breast-feeding mothers to check their nutritional status; provision of micronutrient supplements; conducting awareness sessions on health, hygiene and nutrition; counselling mothers about breast-feeding practices; treatment of Acute Malnutrition.
Sensitising and provision of RUTF
The UK Kidpower is a non-profit organisation in the United Kingdom which encourages increased activity in children while sensitising them to problems of malnutrition in other parts of the world. For every activity that children carry out, they receive points which can be used to procure Read-to-use Therapeutic Food (RUTF). The UK Kidpower has donated £30,000 to UNICEF Pakistan Country Office for purchase of RUTF to be distributed amongst children suffering from malnutrition in South Punjab.
The World Food Programme (WFP)
WFP’s work in Pakistan is aligned Government priorities as defined in their Vision 2025. It supports Government-led efforts to improve food and nutrition security among vulnerable communities affected by law and order operations and the effects of recurring climatic events; work with communities in the most hazard-prone parts of the country to build resilience; address malnutrition; create an enabling environment for women to achieve social and economic equality and facilitate the voluntary return of the displaced in the northwest, as well as assist those still in displacement.
USAID & Aga Khan University to fight malnutrition
It is an agreement between the U.S. Agency for International Development (USAID) funded Sindh Community Mobilization Program (CMP) and Aga Khan University’s Human Development Program. The effort will support nutrition-related activities for children ages 5-9 in CMP schools in seven northern districts in Sindh and five towns in Karachi. As part of the USAID-funded Sindh Basic Education Program (SBEP) - in partnership with the Sindh Education and Literacy Department - CMP is linking schools and health facilities to fight malnutrition. CMP also screens children and creates awareness among parents regarding the benefits of improved nutrition.
