As in other developing countries of the world, malnutrition remains a major public health problem in Pakistan. Malnutrition is poor nutrition caused by a deficiency or excess of nutrients in diet and is the key to morbidity and mortality in children. It includes under-nutrition, over-nutrition and micronutrient deficiencies.
The most common form of malnutrition is called marasmus and results in severe wasting where a child has no fat and very little muscle tissue left on his/her body. The internal organs, including the heart, are also weakened. The child is left with no reserves to fight infection and any illness he or she may suffer is likely to be fatal.
At least 35 percent of child deaths are attributed to under-nutrition. Under-nutrition is one of the threats to global health and child survival, especially in poor and underdeveloped settings. It obstructs the growth and development of children. The damage that occurs from under-nutrition in a child’s first 1,000 days – the window of opportunity when under-nutrition can be prevented from pregnancy to 24 months of age – is largely irreversible. During this period, nutritional needs are wide-ranging in terms of caloric and micronutrient requirements for both pregnant woman and young children.
Poor health, growth and development result from poor nutrition and hunger. Evidence shows that growth failure in a majority of undernourished children begins at around four to six months of age. This is the time when an infant starts receiving complementary foods in addition to breast milk. This deviation from normal growth is a combination of poor nutrition and intra-uterine growth restrictions further aggravated by the burden of morbidity, especially diarrheal diseases (Sharma et al, 2016).
The poor quality and quantity of complementary foods along with inadequate caring practices are the key determinants for this early phase of childhood growth retardation, which has long-term consequences in the late onset of the childhood growth spurt and weak physical and mental capacity (Ferrari, 2002). Micronutrient deficiencies, also called ‘hidden hunger’, are also associated with adverse health outcomes, resulting in an increased risk of morbidity and mortality.
During the last few decades, under-nutrition has decreased globally. However, over-nutrition has been on the rise over the last 10 years. In Asia, malnutrition is decreasing. But South Asia still has the highest rates and largest numbers of malnourished children. Over the past 20 years, there has been little change in Pakistan in the prevalence of malnutrition despite more food availability and an overall increase in per capita caloric intake. This may be correlated to the cross-sectional and multifaceted nature of malnutrition, which also include issues related to poverty, intra-household food security and socio-cultural factors that determine dietary patterns in pregnancy and early childhood.
The environment to which children are exposed also plays an important role in the incidence of malnutrition, especially in areas with a highly dense population, where common parasitic and other diseases inhibit the ability to absorb nutrients. The importance of food quality and food safety cannot be ignored.
In children, a severe form of malnutrition is known as protein energy malnutrition (PEM). It has two types: kwashiorkor – when protein is low in a child’s diet – and marasmus – when your diet is low in both calories and protein.
The other forms of malnutrition include stunting or chronic malnutrition, which reflects a long-term failure to grow during the formative years. Stunted children are at higher risk of death. Wasting or acute malnutrition occurs due to sudden shock, such as the lack of calories and nutrients in a child’s diet due to famine, severe illness or during emergency situations. The term ‘underweight’ entails inadequate weight gain and captures both stunting and wasting in children. In developing countries, stunting is used as a reliable indicator of growth retardation.
At the national level, the rate of stunting is 43.7 percent among children while the rate of wasting and being underweight is 16.8 percent and 31.2 percent, respectively. Micronutrient deficiencies are also widespread. Anaemia is prevalent in 62.1 percent of children, vitamin-A deficiency in 56 percent, zinc deficiency in 36.5 percent and vitamin-D deficiency in 41.1 percent (National Nutrition Survey-2011).
In children, cognitive development and school performance are impaired by poor nutrition and health, with consequent losses in productivity in adulthood as nutritional status and productivity are directly related as measured by labour wages. High levels of morbidity – due in part to insufficient nutrient intake – can reduce work time directly as well as indirectly through the need to take care of sick family members, as it diverts household resources towards medical care. To improve the lives of people in the developing countries, different types of interventions are commonly discussed. But nutrition education is hardly ever included in the list.
During pregnancy, good nutrition can reduce the risk of women delivering low birth weight babies. Infants and young children born with low birth weights have a greater risk for poor growth, and impaired cognitive and behavioural development. To address the problem of malnutrition and reduce the burden of disease, we must create conditions to accelerate economic growth, as poverty is a major factor that contributes towards household food insecurity.
An increase in household income improves the access to food as well as nutritional wellbeing. Consequently, the income effect on the consumption of micronutrients that are found mostly in meat (iron, iodine and vitamin A) is high as compared to micronutrients in vegetables. Therefore, it is imperative to focus on the fortification of foods with micronutrients.
Political will is needed to develop strategies and sustainable policies, and programmes to alleviate poverty and improve household food security. Programmes to accelerate growth in the food and agricultural sector; food quality; food safety; and a regulatory system must be given priority by the government. The latest research technologies may be used as more research is needed in these areas.
We must revisit the following statement: “With diseases related to malnutrition on the rise, the challenge is not only to ensure food security, but also to address the nutritional quality of the food being consumed and its impact on health” (Dr Frenck-G20, 2012).
The writer is a professor at theDepartment of Dietetics and Nutritional Sciences at the University of Lahore’sIslamabad campus.