Malnutrition manifolds as inflation eats into livelihoods

LAHORE: Whether it’s high food-inflation driven or owing to uneducated choices, and an unhealthy lifestyle, malnutrition is afflicting majority of the Pakistani population –the ratio is the highest in the region.

Successive governments went to great lengths in paying lip-service to address this issue, but never came up with low-cost solutions. Most people in the country do not have resources to take two meals a day but even those who can afford to fill their stomachs daily do not eat nutritious food.

The high-cost junk food lack essential micronutrients. The malnutrition problem thus exists in both poor and affluent segments of society. The threat of malnutrition in fact exists even in developed economies. Most of them have addressed the issue through low-cost fortification of foods that are consumed by almost all segments of the society.

Salt for instance is fortified with iodine to eliminate the iodine deficiency. Until recently both iron fortified and plain salts were available in the market. The government of Pakistan about six months back made it mandatory that all packed salt products should be iodised. This would resolve the issue of iodine deficiency for entire population.

In the same way fortification of all edible oil preparations with Vitamin A and D has been made compulsory. The Punjab Food Authority regularly conducts tests to ensure that all edible oils are fortified with these vitamins. This again would help check ailments related to the deficiency of Vitamin A and D.

All the above fortifications are done by manufacturers that charge the consumers. The costs are nominal and do not hurt the buyers much. But there is a broader and more important issue of malnutrition that afflicts majority of Pakistani children and women. It is the deficiency of iron in their body that results in anemia. The anemia in many cases leads ultimately to the death of infants and expecting women.

There has to be a way to supplement iron in the food of entire population. Commodities like salt or edible oil are consumed in low quantities and iron fortification in these two edibles has not been tested globally.

Every developed country fortified it wheat flour that is a staple food of vast number of people in the world. Those countries that have made it compulsory to fortify iron preparation in wheat flour have seen anemia vanishing rapidly. Luckily wheat flour is the staple food of over 80 percent population of Pakistan and its fortification with iron could eliminate the most threatening micro-nutrient deficiency in the country.

We have been aware of this threat and its solution and since 1997 have experimented with many iron compounds to find out the most suitable iron compound that could be fortified in wheat flour.

Many pilot projects under taken in different areas of Lahore and Faisalabad revealed remarkable improvement in the health of population using wheat flour fortified with the approved salt.

In fact Pakistan was well on way to eliminate anemia among its poverty ridden population as 175 flour mills were marketing iron fortified wheat flour in 2011. The fortification was abruptly stopped as the food and agriculture were transferred to provinces on July 1, 2011.

The Ministry of Health through its department of micronutrient initiative was distributing the iron compound to the flour mills for fortifying flour with iron. The iron fortification project was initiated in 1997 and wheat flour, being the staple food of the country, was selected for this purpose.

Iron deficiency is a major cause of red blood cell loss in children and pregnant women in Pakistan. According to UNICEF estimates, iron deficiency affects half of the developing world’s infants, undermines the health of 500 million women of reproductive age and leads to more than 60,000 childbirth deaths a year.

Iron deficiency is also stated to be one of the major causes of high infant mortality rate in Pakistan. It also causes a range of other problems in millions of people, including impaired cognitive development in children, fatigue, maternal mortality and low productivity in the workplace.

According to World Bank, iron fortification costs $0.20/person/year or Rs18/person/year. The total coverage with iron fortified flour would cost only Rs3.27 billion. A supply of worth Rs3.24 billion of this nutrient to flour mills would eliminate killer anemia.

The amount could also be arranged from Benazir Income Support Program or export development fund. World Bank estimates that GDP lost to malnutrition in many developing countries can be as high as two to three percent.

This is because malnutrition slows economic growth and perpetuates poverty through direct losses in productivity from low physical performance and indirect losses from poor cognitive function, academic deficits, compromised schooling, and increased healthcare costs.