Addressing child malnutrition

Published July 8, 2023
The writer is an academic medical researcher and a doctor working for a tertiary care hospital in Karachi.
The writer is an academic medical researcher and a doctor working for a tertiary care hospital in Karachi.

THE rampant malnutrition afflicting children in Pakistan has been a subject of concern for decades. Many substantial studies have been carried out on the topic, including the National Nutritional Survey 2018 (NNS 2018), which shows that 40.2 per cent of children under five years are stunted, while 17.7pc are wasted. While there are many socioeconomic, seasonal and cultural causes for this, one of the leading reasons is inadequate dietary practices among young children. Healthy eating habits in childhood promote optimal growth and nutritional development.

Economic development is imperative for improvement in any country’s food supply and the consequent eradication of dietary deficiencies. This leads to an overall improvement in the nutritional status of the population. Understandably, there is a huge difference between the nutritional status of children belonging to developed and underdeveloped countries. As Chunling Lu writes in his report of 2016, almost 250 million children in low- and middle-income countries (LMICs) are at risk of not attaining their full developmental potential because of malnutrition and poverty. The quality of an adolescent’s life, as well as their physical and scholastic capability, is hugely impacted by dietary habits adopted in childhood. Pakistan too, unfortunately, is severely affected by child malnutrition, ranking 99 out of 121 in the Global Hunger Index.

In most of the developing countries, including Pakistan, the subject of children’s and adolescents’ health is under-researched. The silent nature of nutritional problems, skewed political interests and financial constraints are the main reasons for this. There is also a lack of published data on the subject, which makes it even more difficult to draw the attention of the government, programme managers and policymakers to develop and implement the appropriate guidelines for availability of food in schools.

Considerable effort is being put in nationwide to highlight the importance of food fortification, healthy dietary habits and, most importantly, correct nutritional portions for children. However, young children spend a substantial time of their day at school. Thus, school feeding becomes crucial. Practically, all countries in the world provide their students with some form of school meals. The World Food Programme is a leading humanitarian organisation that has played a pivotal role in devising strategies regarding food at school. The WFP School Feeding Programme (SFP) Strategy, 2020-2030, lays out the vision of a partnership between governments and stakeholders to ensure that all primary school children have access to good-quality meals in school. This also includes a broader integrated package of health and nutrition services.

In Pakistan, only children from a certain socioeconomic setting can enjoy food at school.

Previously limited to more developed countries, the SFP is rapidly drawing the attention of policymakers in LMICs to expand access to education and improve nutrition, and hence, scholastic performance among children. An interesting study was conducted on the outskirts of Peshawar by prominent American nutritionist Nicola Lowe et al. The study compared cognitive function between schools providing a standard meal, a standard meal with micronutrient powder, and a local school where no lunch was provided. The study concluded that there is an improvement in cognitive performance in children who received a school meal with and without micronutrient powder over a 12-month period. Pakistan currently has no operational school food programmes at the national or provincial level.

The Tawana Pakistan Project, a joint venture funded by the government from September 2002 to June 2005, was the last substantial step towards school meals. The project itself experienced multiple bureaucratic issues, especially at the district level, as well as other bottlenecks.

Like many other resources, food availability at school is also a privilege that only children in a certain socioeconomic setting enjoy in Pakistan. Another report published in 2018 by Ayesha Aziz et al, analysing the dietary practices of schoolchildren in Pakistan, concluded that skipping breakfast and snacks was related to low socioeconomic status and rural residence. In such an unequal society, the responsibility of the government is even greater to provide school meals in all government schools.

Beset with serious economic and political problems, in addition to bad and inefficient governance, Pakistan’s government is already struggling on many fronts. Expecting the state to provide quality meals in public schools that are already providing free or cheap education would be unreasonable. The role of NGOs and other volunteering organisations can be considered in this regard. The private school sector provides cleaner and better food options to children, yet the lack of a central policy for standard food provision in even these institutions is worrisome. The preferred way of most Pakistani parents is to send their children to school with packed lunchboxes and tiffin. Understandably, the lack of trust in food items available in school canteens and cafeterias is one of the many reasons. But these canteens and cafeterias may become a necessary choice for some parents. With more middle-class women opting to work, it is the need of the hour that they should be less worried about their children’s food provision at school.

Developed nations like the US have school meals free of charge or at government-subsidised prices for students from low-income families. Though this is an unrealistic expectation from the government with its current economic and political struggles, small and effective steps can be taken in this direction. The government should look into formulating dietary guidelines for food items available for consumption by students. The quality of food should be up to the mark to ensure decent health standards, with a focus on fortification. The availability of soft drinks, sports energy drinks and excessive sugar should be discouraged. Canteens should, instead, serve nutrient-rich, fortified foods such as milk, vegetable and meat items, seasonal fruit and other items catering to the macro- and micro-nutrient needs of children, including iron, calcium, B-vitamins, etc. Lunchtime should be clocked according to the hunger levels of the children, and excessive periods of starvation should be discouraged.

We are far from the goal, yet and these issues might look simpler and smaller in comparison to other grave problems the country is currently facing. Yet, the importance of developing healthy eating habits and providing appropriate nutrition to school-going children is paramount and cannot be ignored.

The writer is an academic medical researcher and practising at a tertiary care hospital in Karachi.
navaira_ali@hotmail.com

Published in Dawn, July 8th, 2023

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