KARACHI: The alarming prevalence of vitamin and mineral deficiencies in children is undermining Pakistan’s ability to achieve its development potential, noted experts during a three-day international conference, which concluded at the Aga Khan University (AKU) on Saturday.

They also called upon the government to adopt a more comprehensive approach towards early childhood development to enhance its far-reaching impact on human and social development.

A major highlight of the conference titled ‘Nutrition and Early Human Development’ was the National Nutrition Survey 2018 whose findings were discussed and analysed in detail during the event.

‘Poverty not the sole cause of malnutrition’

The survey shows that the country faces a triple burden of malnutrition with micronutrient deficiencies, undernutrition and obesity co-existing in Pakistan’s population.

Over six out of 10 children (62.7 per cent) across the country are vitamin D deficient while more than half of under fives (53.7pc) suffer from anaemia or a lack of vitamin A (51.5pc).

Only one in seven children between 6-23 months of age receive meals with minimum dietary diversity that include four food groups. Furthermore, fewer than one in 20 children (3.6pc) are fed complementary foods that would ensure optimal growth.

These nutrition deficits, according to speakers, are present across all socioeconomic strata and are noticeable in the country’s most affluent areas.

“Poverty isn’t the sole cause of Pakistan’s malnutrition challenge as vitamin and essential mineral deficits also prevail in the wealthiest households,” said Prof Zulfiqar A. Bhutta, founding director of Aga Khan University’s Centre of Excellence in Women and Child Health.

Pakistan’s nutrition challenges, he noted, were not just the responsibility of the ministry of health as malnutrition affected indicators in education, gender equity, as well as the country’s ability to address social inequalities.

“That’s why we need solutions that cut across sectors such as agriculture, education and clean water and sanitation, which actively involve parents and communities,” he observed.

Prof Bhutta in his presentation also referred to Pakistan’s long-running programmes to fortify cooking oil, ghee and wheat with vitamins and noted that the levels of vitamin A and vitamin D deficits and severe iodine deficiency had risen since the last survey in 2011 despite those programmes.

Broader role of LHWs

As part of measures to address the challenge of nutrition deficits in children, speakers suggested a broader role of lady health workers who could be trained and tasked to educate families on the importance of key minerals in child growth and health awareness sessions targeting primary schoolchildren.

They expressed concern over the fact that the country lacked a complementary food strategy and called on the government to form a multi-sector working group to lead efforts in this area.

Dr Ghazala Rafique, director of AKU’s human development programme (HDP) in Pakistan and the conference co-chair, said a thriving child needed access to much more than just healthcare and education.

Adequate nutrition, equal access to opportunities and a safe, stimulating home environment, in her opinion, were some of the many other determinants of a child’s well-being and required integrated policies and strategies at the government level.

Pakistan’s health and education systems, however, tend to work in isolation which resulted in many missed opportunities, she observed.

In this context, Dr Rafique shared that mothers who brought their children to a basic health unit for vaccination could easily be informed of the importance of creating a stimulating learning environment at home.

Similarly, she noted that schools could make a contribution to good health and nutrition by incorporating health messages into the curriculum.

Professor Kofi Marfo, director of AKU’s Institute for Human Development (IHD), said often education was viewed from the level when a child stepped into a school, though a child’s peak brain development occurred in the first year of life.

“This suggests that the education ministry needs to broaden its focus beyond schools and to explore how parents can be motivated to create a stimulating learning environment in the home,” he observed, emphasising that a political will was required to get things implemented to make a real-world impact.

During the course of discussion, experts also called for the creation of a ministry for child health in Pakistan that would enable a long-term approach to address the country’s interconnected development problems.

There was a consensus that Pakistan required a parliamentary caucus that would ensure children’s interests and the value of early childhood development remained on the legislative agenda.

Published in Dawn, October 27th, 2019