A strategy on malnutrition

Malnutrition is the result of having insufficient nutrients in one’s diet. In Pakistan, it takes a heavy toll on the adult and child population in the form of high morbidity and mortality rates.

Similar to global patterns, in Pakistan pregnant women, and children under the age of five are at high risk of micronutrient deficiency. Findings of the National Nutrition Survey 2011 showed that household food insecurity stood at 58 percent, and that 44 percent of our children less than five years of age are stunted, 32 percent underweight, 15 percent wasted and 62 percent iron deficient.

Underweight mothers are 18 percent, 14 percent and 20 percent at the national, urban and rural levels respectively. In addition, anaemia and other micronutrient deficiencies – such as of iron, zinc, iodine, vitamin A and D – are also prevalent in the country at a large scale. In the Global Food Security Index 2014, Pakistan was on the 77th position amongst 109 countries.

Besides pathological effects, malnutrition has a profound impact on human behaviours and performances, affecting societies and resulting in poor health among the population. Lower educational attainment, decreased work capacity and earning potential are major outcomes in a community facing malnutrition. A healthy population contributes to increased national growth and productivity. There is a dire need for more political will and collaborated efforts, both by the public and private sectors, to accelerate progress on the challenge of under-nutrition.

In addition to inadequate food intake, food insecurity and compromised water and hygiene systems, one of the major reasons for poor health indicators in Pakistan is lack of awareness among communities regarding malnutrition. Most people think that high energetic food may also provide good nutrition. The Punjab Policy Guidance Note on Nutrition reveals a strong relationship between indicators like poverty and women’s education and malnutrition. To overcome this issue, robust efforts would be required  to create awareness for behaviour change in such a way that can effectively communicate with those who are less educated, and especially mothers.

A holistic approach comprising both preventive and curative methods is essential to improve nutrition indicators. As a preventive measure, a Nutrition Awareness Programme should be introduced by the government with the aim to enhance knowledge within communities about nutrition. The target population should be accessed at a household level. Although the government already has a network of outreach staff, including lady health workers, community midwives and school health nutrition officers, there is a need to strengthen their services through trainings and capacity building.

Frequent lessons and reinforcements, especially focusing on a 1000+ days approach, highlighting the significance of the time period from conception till the first 24 months of a child’s life (when irreversible damage from malnutrition is likely to occur) should be utilised. Besides an awareness program, provision of iron, folic acid tablets, Vitamin A supplements and biannual de-worming of children should also be assured through a network of outreach staff.

In Pakistan, there is a strong network of humanitarian organisations and international NGOs working on the development sector including health. For example, the World Food Programme and the UN are mandated to inform people regarding nutrition in emergencies and disastrous conditions. They can be quite effective in educating a community during times of emergency because of their rich resources in the form of equipped logistics and human expertise, something our government might be lacking.

But because local government has good access to communities, collaborative efforts by the government and such organisations to implement interventions with shared nutrition goals and to mobilise resources effectively can be strategised to address the issue at a larger scale. The media can be a strong tool for dissemination of information and knowledge. Very often, crucial issues are highlighted and discussed only after they highlighted by the media. This is why the media can be widely used for advocacy and awareness of nutrition issues in a non-technical manner for a clearer understanding by the audience. Popular media channels should be used to advise the public about the reasons of malnutrition and how to overcome them and also to educate people about the concept of a healthy community.

Although there have been many initiatives in the past, the country is still facing a daunting situation and lagging behind in achieving the Millennium Development Goals. There is no doubt that with the existing policies and a growing population, the set targets cannot be achieved unless the political leadership is sensitised on the relationship between economic progress and healthy populations.

To improve nutrition indicators, political entrepreneurs and policymakers must play their due role and promote and support the sensible course of a healthy and prosperous community.

The writer is a public health specialist.