KARACHI: Health experts at a symposium held at the Aga Khan University (AKU) auditorium on Tuesday expressed serious concern over the recently launched National Nutrition Survey (NNS) 2018, which shows that Pakistani children and mothers continue to be at a high risk of mortality and morbidity due to various forms of malnutrition, reflecting persistent failure of successive governments in tackling the health crisis.

Titled ‘Childhood malnutrition scientific evidence’, the event was organised by the department of paediatrics and child health of AKU.

The NNS 2018 is the fifth national nutrition survey since 1965 but the first to yield district-representative data and to include adolescents and a component on water.

The study group included under-five children, women of reproductive age and adolescent boys and girls.

According to the key findings of the survey, stunting is a major problem in Pakistan, with 12 million children with low height for age.

The national average (40.2pc) for stunting masks provincial disparities. The average annual reduction rate is estimated at 0.5pc, too slow to significantly reduce the stunting rate in Pakistan.

The prevalence of stunting varies from 32.6pc in ICT (Islamabad Capital Territory) to 48.3pc in Khyber Pakhtunkhwa-NMD (newly merged districts previously called Fata).

“The prevalence of stunting among young children in Sindh (45.5pc), Balochistan (46.6pc), KP-NMD (48.3pc) and Gilgit-Baltistan (46.6pc) is higher than the national average. Its prevalence in Punjab is 36.4pc, 39.3pc Azad Jammu and Kashmir and 40pc in Khyber Pakhtunkhwa,” said Dr Zainab Sheikh of AKU’s Centre of Excellence in Women and Child Health, also a master trainer for the survey.

According to her, the prevalence of low weight for height (wasting), a strong predictor of mortality among under-five children, is on the rise in Pakistan, from 8.6pc in 1997 to 15.1pc in 2011 and 17.7pc in 2018.

“Despite improvements in other socioeconomic indicators, acute malnutrition remains in a state of nutrition emergency. This is the highest rate of wasting in Pakistan’s history,” she said, citing the report.

This form of malnutrition, according to the report, is most prevalent in Sindh (23.3pc) and KP-NMD (23.1pc), whereas Gilgit-Baltistan and ICT have the lowest proportion of children with wasting, at 9.4pc and 12.1pc respectively.

Double burden of malnutrition

Regrettably, while stunting is on the rise, obesity is also increasing among children in the country, which the report describes as “the double burden of malnutrition”.

“It is becoming increasingly apparent, with almost one in three children underweight (28.9pc) alongside a high prevalence of overweight (9.5pc) in the same age group.

“The prevalence of overweight among children under five has almost doubled over seven years, increasing from 5pc in 2011 to 9.5pc in 2018,” it says.

The pattern of distribution of malnutrition among boys and girls remains the same, with boys being more affected than girls by all forms of malnutrition.

Children living in rural areas suffer more from undernutrition (stunting and wasting) than their peers in urban areas. Obesity affects children equally, irrespective of locality.

Anaemic kids

Presenting various slides on the NNS with graphs and tables, Dr Sheikh told the audience that more than half (53.7pc) of Pakistani children were anaemic and 5.7pc were severely anaemic.

“The prevalence of anaemia is slightly higher (54.2pc), amongst boys than girls (53.1pc). Children in rural areas are more likely to be anaemic (56.5pc) than in urban areas (48.9pc),” she said, adding that a significant number of children also suffered from deficiencies of various vitamins and minerals important for mental and physical growth.

The information shared and discussed during the programme suggested that nutritional deficiencies are generally not addressed as children grow up. This situation gets critical in cases of girls once they get married and become pregnant; the baby of a malnourished woman is more vulnerable to mortality and morbidity. The society is a loser in the process, too.

In Pakistan, according to the report, more than half (56.6pc) of adolescent girls in Pakistan are anaemic. Sindh has the highest proportion of iron deficiency anaemia with about a quarter (23.8pc) of all women of reproductive age affected, followed closely by Balochistan (19pc) and Punjab (18.7pc).

About 41.7pc of women of reproductive age are anaemic, with a slightly higher proportion in rural (44.3pc) than urban settings (40.2pc).

“This shows failure of our health system for which we need to hold the government responsible. There has to be a policy change aimed at the welfare of the poor,” said Prof D.S. Akram, a senior paediatrician.

Dr Jai Das, Dr Najeeha Talat Iqbal, Dr Ali Faisal Saleem, all from AKU, gave separate presentations, sharing data of various studies on malnutrition.

They were of the opinion that cost-efficient interventions, which had been proven effective in other low-income settings, could improve the status of child and maternal health in the country and the government must make use of them.

Published in Dawn, July 11th, 2019