Nutritionally Challenged Pakistan?

It is said that we are what we eat, and data tells us that Pakistanis are not eating enough, and not eating right enough! Choice does not play a very great part in either of these cases. This is a nation of over 245 million people with an average annual growth rate of 2.4%, and fertility rate as high as 3.6, as mapped during 1998-2017 period covered by the last census.

This is also a nation that has been waxing lyrical about its ‘youth bulge;’ The fact that by 2030 more than 60 % of its population will be under 30 years of age. But the realization that needs to sink in is that the bulge made up of a large number of malnourished, wasted and stunted youth will not bear a positive dividend for the country. Instead it will be a drain on national resources as well a source of lifelong stress and disappointment to their families.

Figures drawn from reports from FAO, as well as the 2018 National Nutritional Survey show that almost half the children under 5 are suffering from these developmental deficiencies. The 2017 census revealed that the largest demographic group is between the ages of 5-9 years. If the children mapped in 2018 by the National Nutrition Survey were 5 years or less, by 2030 they will be on the threshold of the ‘youth’ bracket, and about to make their entry into that ‘bulge.’

We are also a country that ranks amongst the top ten vulnerable to climate change, and not just a highly vulnerable country but one that is a multi-threat country. The compendium of threats extend beyond floods, which have garnered the maximum attention due to their geographic extent and physical damage.

The other challenges of desertification, water and heat stress on humans and decrease in crop productivity, and in turn, its macro and micro-nutrient value have come into focus only recently. Even if one took the case of the 2022 floods, a 53% increase in the case of malnutrition was registered by the related agencies and authorities due to the difficulties in access and distribution of food.

Whichever way we look at them, the numbers do not present a pretty picture. We must also bear in mind that all these figures have human faces, and stunted, malnourished faces do not present a pretty picture either, especially our most vulnerable and precious; our children!

These children need to have a better future. In fact they need to be a part of crafting a future for themselves and the country. However, this is exactly what malnutrition, stunting and wasting prevents. Nutritional deficiencies lead to delayed developmental milestones, posing physical challenges and cognitive challenges.

If we are to move towards meeting the Sustainable Development Goal commitments, for which we have only 7 more years to reach the goal post, immediate, intensive measures will be needed to address the issue that has ballooned to the proportions of an emergency.

It may require to move rapidly through the SDG grid by aiming to address Goal 2 calling for the achievement of Zero Hunger, which are directly linked to the next four goals of Good Health and Wellbeing (Goal 3), Quality Education (Goal 4), Gender Equality (Goal 5), Clean Water & Sanitation (Goal 6), and treading the pathway to reach Goal 17 calling for partnerships for the achievement of the SDG targets.

One way of course is to get the inequitable developmental paradigm on an even keel to reach all children under 5 years of age. This is easier said than done. SCANS, the School Age Nutrition Survey of 2020 indicates that almost 90% of the children suffer from Iron deficiencies. This had earlier been identified as the top deficiency by the National Nutrition Survey of 2018.

Micronutrient and macronutrients were found to be well below the Acceptable Macronutrient Distribution Range. For instance, 30% above the AMDR for total fat, while 10% are above the AMDR for carbohydrate. The situation is no less alarming where micronutrient deficiencies are concerned. Data shows that more than 80% of children are below calcium, iron, zinc, and vitamin A recommended intakes, 60% for vitamin C, 25% for B-vitamins, and 75% for folate.

These deficiencies manifest themselves through impaired growth, frequent illness, fatigue, shortness of breath, and a reduced ability to learn. This leads to absence from school, and also hinders the physical and cognitive development of children.

The Aga Khan University conducted a health economics study and calculated the cost of income loss to the tune of US$ 3 Billion annually or 1.33% of GDP. Direct medical costs of micronutrient deficiencies (in 6-23 month old children) are estimated at US$ 19m.

What do these numbers tell us? There is a clear emergency at hand, and needs to be dealt with by recognizing it as an emergency. Like in the times of disasters, this too requires a mapping, strategic planning, and resource mobilization to tackle it.

While on a broader level, there needs to be Research and Development into better, more nutritious crop varieties, efforts at behaviour change about dietary habits through introduction of a greater variety in intake, some focused interventions will also be needed.

One clear fix is the addition of the missing nutrients, macro and micro, in the diet of the group of children mapped under SCANS. This can be done by providing these school children with age specific, complimentary fortified nutritious food and dairy solutions. Such food fortification interventions demand the recognition of the emergency nature of the need, and adequate resource allocation.

However, some other solution will have to be devised for the over 25 million out of school children of Pakistan, as well as those whose normal education is disrupted during disasters, displacement and climate-induced migration. Their numbers are growing exponentially, and they need to have access the solutions being devised to increase the nutritional intake of school children.

Focusing on the health and nutrition of this very important demographic group is crucial to their individual development, wellbeing and prosperity, but the same goes for the country.
Physically and mentally healthy children will be the biggest contributors to the nations’ health.