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Crisis of malnutrition

June 12, 2013

Hilda Saeed explores the genesis of pervasive malnutrition in the country

The elections are finally over; winning politicians and associated bigwigs are now keen to move the country towards economic stability. They are determined to avoid the inevitable kashkol and the IMF.

Nawaz Sharif has already called a significant meeting on the economy: high priorities have been identified as halting the country’s fiscal downslide, improving and stabilising the economy, the tax system, law and order and combating terrorism. There are other, equally daunting challenges: poverty remains an outstanding one, closely linked to the national economy.

Growing poverty has led to escalation of hunger — chronic, acute and deep-seated. Last year the World Bank reported on Pakistan’s high rate of child malnutrition and noted the world’s highest levels of vitamin and mineral deficiencies among women and children. The World Health Organisation (WHO) considers malnutrition the single greatest threat to public health.

This undernourishment seriously damages growth and height of children and women and increases their susceptibility to infection, yet it remains hidden, rarely reported in the media, because it is the poor who are affected, and they’re marginalised, almost invisible. With the recent national catastrophes, numerous people have been displaced; the situation has worsened with terrorism. Food insecurity is a critical outcome.

The Pakistan Medical Association (PMA) is concerned: “Extremely low health expenditure prohibits the outreach of healthcare. We need mass education, political stability, economic growth and total eradication of corruption for a modern health system. The PMA strongly believes that the government should spend at least 6pc of the GNP on public health.”

The Pakistan National Nutrition Survey 2011 is a damning indictment of the country’s alarming levels of poverty. The comprehensive survey covered, 30,000 households from all the provinces. Sindh, Balochistan and Khyber Pakhtunkhwa were found to be more severely affected than Punjab. Overall, 60pc of the country’s women and children are malnourished — that’s more than half of the population. Interestingly, men aren’t so badly affected: does that point to gender inequalities that exist even in food distribution within the family?

Malnutrition is worsened by illiteracy, especially among women, and by massive socio-economic disparities that add to the pain of chronic hunger on the one hand, and extreme food wastage on the other.

Nourishment, plain and simple, is a necessity for everyone. It can be specialised for those who need it — babies, diabetics, seniors, athletes, patients in hospitals. For the rest of us, adequate proportions of the good old proteins, carbohydrates, fats, vitamins and minerals that we all learnt about in school, should suffice.

Since women, as a group, are so badly undernourished, it’s pertinent here to emphasise their special nutritional needs, especially during pregnancy and lactation. Their food should be rich in iron, protein, iodine, vitamin A, folate and other nutrients. Deficiencies at this stage can lead to foetal and newborn birth defects and decreased physical and mental potential. Lactation places high demands on maternal stores of energy, which need conservation and replenishment.

The importance of nutrition for babies and children cannot be ignored. Paediatrics Prof Mahmood Jamal of the Pakistan Institute of Medical Sciences commented on Pakistan’s numerous problems for maternal and newborn health that arose from chronic malnutrition: “When a mother stops breastfeeding, it affects the nutrition cycle of the child and leads to repeated infections.”

Some scenes are unforgettable. Years ago, while on a field trip, we entered a hut, and were met by four wailing kids, ranging in age from toddler to about six or seven. They bore mute testimony to the fact that they were born in quick succession. In a corner lay an old woman, clearly sick and infirm. In the centre was a younger woman, listlessly flicking flies away from her baby — visibly malnourished, dry and wiry hair, dull eyes, and listless, hugely distended tummy. The mother herself was pale and weak. The doctor in our group coaxed her to come to the nearby basic health unit in an hour’s time: she was worried about the baby’s survival. That, in a nutshell, highlights the tragedies of poverty-stricken lives — minimal food, little or no healthcare or population planning. That Pakistan has lagged behind in achieving the UN Millennium Development Goals related to maternal and child health is hardly surprising.

Malnutrition is affecting everyone: severely malnourished children show marked behavioural changes; they may be apathetic, less active, depressed, underweight, show poor growth, and may experience muscle weakness.

Continued malnutrition can cause swollen gums, decaying teeth. Organ malfunction may occur, leading to coronary heart disease, osteoporosis or other ailments. The imprint left on the brain by nutritional deprivation, especially in earlier life stages, leads to lifelong learning and memory deficiencies, lower IQ and school achievement; behavioural problems may arise in childhood and adolescence.

Food deficiencies and mental health problems are interlinked: conditions such as bipolar disorder and schizophrenia seem to involve functional deficiencies of certain highly unsaturated fats like Omega-3 found in fish oils. Dietary supplementation with vitamins, minerals and essential fatty acids has even been known to improve antisocial behaviour and violence in prisoners.

Food deprivation can occur in the presence of physical and/or emotional abuse, or when drug abuse causes a person to neglect intake of nutritious food. Caregivers too, of infants, children or seniors, may end up neglecting themselves in the process of giving care to others.

At this critical juncture, even now, at least some cost-effective, low-cost ways can be found to improve food security for the population. Pakistanis give generously: witness the large numbers of people who are provided daily meals all over the country. Other than that, there’s kitchen gardening, breastfeeding and awareness of putting together inexpensive, nutritious meals. The media can play a far bigger role than it does currently.

Food security is essential for gradually eliminating malnutrition. Even small steps can and must be taken; they spell part of the legacy that we will leave for our children.