Our health predicament
June 2019 marked the release of the results of the largest ever nutrition survey conducted in Pakistan. The National Nutrition Survey 2018 places a question mark on the future of our generation, especially in regard to healthcare as the population ages.
To devise necessary solutions, it is imperative to first understand the problem. When it comes to children and malnutrition, the terms ‘wasting’ and ‘stunting’ are frequently used to describe the effects poor dietary habits have had on them. John Waterlow introduced these terms in the early 1970s for underweight children, from those who had a low weight in relation to their height (wasted) to those who were small for their age (stunted). It is implied, however, that although wasting is a short-term health issue, repeated episodes of it may lead to stunting, which can be fatal.
Delving into some of the statistics from the survey, in Pakistan, four out of ten children under five years of age are found to be stunted whereas 17.7 percent suffer from wasting and every one in three children is underweight (28.9 percent). The prevalence of stunting varies across the country, with 32.6 percent in the Islamabad Capital Territory (ICT) to 48.3 percent in Khyber Pakhtunkhwa-Newly Merged Districts (KP-NMD); the incidence of stunting among young children in Sindh, Balochistan, KP-NMD and Gilgit-Baltistan (GB) is higher than the national average.
Poor feeding practices, maternal nutrition, and poor sanitation can be deemed responsible for this. This is a larger problem especially in Pakistan’s rural areas where due to lack of proper information malnutrition has increased. Dietary habits for women during pre-pregnancy, pregnancy and over the initial two years of the child’s life are of utmost importance for the survival and proper development of children and mothers. Addressing these nutritional requirements of pregnant and lactating women is now also deep-rooted within the UN’s Sustainable Development Goals.
An example would be the myths and superstitions regarding colostrum, which is the first secretion of milk after giving birth. The majority of the population rely on ‘ghutti’ and honey in the first hour of birth while according to the WHO the infant should only receive breast milk without any additional food or drink, not even water.
Unfortunately, most of the rural population is not aware of the importance of colostrum and its role as the baby’s first immunization as it helps reduce infant mortality. It also has several other nutritive benefits and depriving an infant of this could result in malnutrition, morbidity or even death.
In addition, due to poverty and lack of awareness regarding proper nutrition, villagers prefer to sell the primary sources of nutrition such as dairy, meat and eggs rather than consuming them, thus further exacerbating deficiencies such as anaemia or Vitamin A deficiency. According to the National Nutrition Survey 2018, more than half (53.7 percent) of Pakistani children are anaemic and 5.7 percent are severely anaemic which has serious effects on a child’s growth affecting their mental development.
Around 51.5 percent of children have vitamin A deficiency, of whom 12.1 percent have a severe deficiency. According to the WHO, Vitamin A deficiency is the leading cause of preventable blindness in children and increases the risk of disease and deaths from common childhood infections such as diarrhoea and measles. Most of these micronutrient deficiencies can be easily prevented by habitual consumption of fruits and vegetables.
Apart from feeding practices, sanitation and water pollution play a detrimental role in the worsening health situation of children in our country. Infant-deaths caused by water-related diarrhoea are 60 percent in Pakistan; this is the highest ratio in Asia. Groundwater is found to be contaminated at source with contamination levels rising in water storage devices. Most rural areas for example have leaching pits or are of open drain variety that are created in close proximity to water pumps. This is where the contamination commences, especially where the aquifer is shallow.
Untreated faecal waste is further concentrated around human settlements due to open drain toilets ultimately entering surface water systems and spreading the contamination. The dumping of faecal waste in trash heaps around villages further increases the level of contamination to surface soil. The untreated wastewater is routinely mixed with ground and surface water for crop irrigation, further creating a chain that includes contaminated food that is grown and distributed among the major urban centres of the country for consumption. Altogether, this chain of contamination multiplies the oral transmission of faecal bacteria affecting rich and poor alike.
According to the UNDP, 64 percent of Pakistan’s population is under 29 – making it one of the youngest populations in the world. Keeping this in perspective, we have to understand that the bulk of the effects of unhealthy dietary habits will eventually occur later in the precarious stages of life. We need a conscious effort to rectify these habits so a disproportionate burden on Pakistan’s already fragile healthcare can be avoided.
History teaches us that only nutrition-specific interventions can fail due to weak incentives, institutions and infrastructure. Therefore, the way forward should include nutrition-sensitive interventions as well. Nutrition-specific interventions such as iron, folic acid and multi-vitamin supplementation are needed to curb the incidence of anaemia and vitamin deficiencies that is plaguing our children.
Inclusion and empowerment of women is also a key way of overcoming malnutrition as the asymmetries in power between men and women along with their constrained health and social status limits their ability to properly care for their children in the critical early years.
These interventions together will reduce stunting and wasting, especially in rural areas. But most importantly, public investment in water or sanitation systems is required as dietary, curative and behavioural developments will not be sustainable unless the total faecal burden in the environment and the use of untreated wastewater for crop irrigation is controlled.
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The opinions expressed in this article are the author's own and do not necessarily reflect the viewpoint or stance of SDPI.