Transcript Some points to ponder - Allama Iqbal Open University

An Overview of Food And Nutrition Situation
in Pakistan
Freedom from hunger and malnutrition is a basic human
right. Nutrition has been expressed as a right in various
international declarations and human rights instruments
from time to time. According to UN Article 24, states are
mandated to provide medical assistance and health care to
all children, combat disease and malnutrition through
provision of adequate nutritious foods, safe drinking water
and adequate sanitation and provide families with
information about the advantages of breast
feeding.
Intake of Food by Food Groups
Food groups
Per person per day
(gm)
Distribution of food among Adult Males (%)
Urban
Total Cereals
426
Wheat
362
Rice
38
Other Cereals
26
Fat and oils
39
Sugar
80
Roots
Rural
99
99
98
96
38
31
38
Pulses
18
33
33
Meat
36
36
24
Fish
7
4
4
Eggs
6
11
6
Milk
411
38
59
Vegetables
94
54
41
Fruits
88
5
2
Tea
2
82
64
Source: FAO (2000). Food Balance Sheet. Rome. National Institute of Health (1988). National Nutrition
Survey, Islamabad.
Dietary Pattern of Adult Males (%) in
Different Provinces
Food Type
Punjab
Sindh
NWFP
Balochistan
AJ&K
Cereals
98
99
99
98
100
Fat & Oils
98
100
97
89
100
Roots
14
54
42
36
6
Pulses
30
41
25
32
38
Meat
27
24
34
41
50
Fish
1
2
0
14
1
Eggs
10
8
5
8
14
Milk
57
72
17
27
14
Vegetables
64
29
30
27
75
Leafy
Vegetables
5
10
6
3
5
Fruits
6
2
6
2
5
Tea
71
43
97
96
90
Source: National Institute of Health (1998)
National Nutrition Survey, Islamabad
Availability of Dietary Energy from various
Food Groups
Available Calories per head per day
Food Groups
1990
2000
Desirable
1393
1274
924
Pulses
58
61
139
Vegetables & Fruits
75
102
231
Total Animal Products
237
430
462
Added Fats & Oils
324
302
231
Sugar & Honey
265
283
185
Others
40
0
60
2392
2452
2310
2310
103.5
106.1
Total Cereals
Total Calories
Average Requirements
Calories % Requirement
Sources: FAO (1990, 2000) food Balance Sheet. Rome
Pakistan is not a food insecure country.
Quantity and Nutritional Quality of Diets
Available During 1990 & 2000
Indicators
Per capita
1990
Per day
2000
2392
58.4
58.5
2452
62.5
64.2
Criteria for balance diet
Quantity
Calories
Proteins (g)
Fats (g)
Quality
Percent Calories from:
Protein
9.8
Carbohydrates 68.2
Fats
22.0
10.2
66.2
23.6
10.-15
55-70
20-30
Causes of Malnutrition
 Poverty
 Shortage
of food
 Maldistribution of Food
 Infections
 Ignorance
Food Insecurity Profile – District Wise
Calories/Capita/day of all food
(Consumption Vs. Production)
Punja
b
NWF
P
Sindh
Baloc
histan
N.A
AJK
FATA
High
Insecu
re
4
20
3
15
4
7
7
Mediu
m
Insecu
re
3
3
1
4
1
-
-
Secure
27
1
13
5
-
-
-
Source: State of food insecurity in rural Pakistan. SDPI, 2003.
National Outlook: Out of 120 district settings, 74 (62%) were found to be food deficit.
Nutritional Status
Nutrient Intake of School Girls (6-15 Years)
% of RDA
Calories
Protein
Iron
86%
118
67
Prevalence of Malnutrition (Under Five)
Low birth weight
Under Weight
(Low Weight for Age)
Stunting
(Low Height for Age)
Wasting
(Low weight for Height)
Anemia
(Iron Deficiency)
Goitre
(Iodine Deficiency)
School age children
Bitot’s Spot
(Vitamin A Deficiency)
25-34% (1.42 -1.94 million)
40% (9.5 million)
50% (12 million)
9% (12 million)
51%
77%
5.8%
Incidence of Malnutrition (Under five) in
Pakistan
Malnutrition
NHS
NNS
FAO___________
Indicators
1990-94
2000-02
1990
1999-2000
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Underweight
39%
38%
Stunting
35%
37%
35%
50%
Wasting
14%
13%
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Child Mortality in Pakistan
Mortality/1000 live births
1990
1999
Infant mortality
104
90
Under five mortality rate
138
126
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Cost of Malnutrition
Malnutrition costs the country Rs 200 billion every year equivalent of more than 5% of
GNP in lost lives, disability and productivity.
Breast Feeding Practices
Duration
0-3 months
6-9 months
UNICEF
1990
2000
87%
74%
16%
31%
NNS
2000 - 2
62%
35%
Other Indicators Related To Child Nutrition
Infant mortality rate
Under five mortality rate
Adult female literacy rate
Female literacy as % of males
Number of children out of school
Number of girls out of school
Primary school enrollment
Middle school enrollment
Secondary school enrollment
Drop out of rural girls at primary school
Level
Rural girls (12 year old) continue school
Rural boys (12 year old) continued school
Coefficient of educational efficiency
No of Government primary school
Without water and sanitation facilities
No of primary school without shelter
And boundary wall
90 per 1000 live births
126 per 1000 live births
24%
48%
8.2 million
5.9 million
46%
16%
52%
75%
3%
18%
68%
90%
50%
Quality of Life
Poverty
% population below poverty line
% population below $ 1 a day
% population below $ 2 a day
New born weighted at birth (%)
Babies registered at birth (%)
Breast feeding practices
0-3 months (%)
6-9 months (%)
Access to sanitation
(% of population)
Access to improved water source
(% of population)
Parasitic Infections
(% of population)
Consumption of iodized salt
(% of households)
Vitamin A supplementation
(% coverage of pre-school children)
Physicians (Per 1000 people)
Health Expenditure (% of GDP)
Education Expenditure (% of GDP)
Economic cost of Malnutrition
(Billion rupees per year)
Life Expectancy
Males
Females
34
31
85
12
30
16
31
30
60
60
19
1
0.6
0.9
2.7
200
(5% of GDP)
61 years
63 years
REPRODUCTIVE HEALTH
Female Population
(% of Total)
48.2
Total Fertility
(Births per Women)
4.8
Adolescent Fertility Rate
(Births per 1000 Women)
100
Contraceptive Prevalence Rate
(% of Women)
24
Pregnant Women Receiving Prenatal Care
27
Births Attended By Skilled Health Staff
(% of Total)
19
Prevalence Of Anemia
(% of Pregnant Women)
37
Maternal Mortality Rate
340/100,000
(600,000/ year)
Indicators Indicating the Progress of a Nation
% of children adequately nourished
% of being educated to at least 5th grade
% of children surviving to age of five
National Performance Gap *
Children under five mortality
-27%
Children under weight
-13%
Children reaching grade five
-18%
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*
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*
A measure of the extent to which positive child right are being honored in
relation to available resources.
Country has not achieved considerably social progress
Low level of education and poor health and nut status are limiting pale
productivity and adversely affecting economic growth and poverty redirection
prospects.
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Indicators for Assessing and Monitoring Nutritional
Problems
Food Crises
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Production patterns
market prices
Food stocks
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Fall in body weights
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Protein – energy malnutrition
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Micronutrient deficiencies
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Iron deficiency : rates of anemia
Vitamin A deficiency: night blindness/xerophthalmia
Iodine deficiency: goiter, cretinism
Household food security
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Children’s anthropometry (weight for height for age, weight for
Children's’ growth
Infectious disease rate
Food intake relative to need
Body mass index
Employment levels
Market prices
Changes in real income and purchasing power
Dietary energy supply
Caring capacity
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Maternal education
Maternal employment, public expenditure
Literacy rates
Breast feeding (duration and percentage)
age, height for weight)
NUTRITIONAL CHALLANGES
 Poor
Household Food Security
 Low Birth Weight
 Child Feeding Malpractices
 Childhood Under-Nutrition (PCM)
 Micronutrient Deficiencies
(Vitamin A, Iodine, Iron, Zinc)
Interventions for Improving Nutrition Status
Interventions
Benefits
Breast Feeding
Improved breast feeding practice
and reduced bottle feeding
Can reduce child malnutrition
mortality and can save more
children
Improved Food Intake
Per capita food availability
During pregnancy
Vitamin A Supplementation
During Pregnancy
To new born in the first 48 hours
Improved Health Environment
Improved Education Level Of Mothers
Primary School
Secondary School
Income
Increased per capita income by 10%
Can reduce child malnutrition
by 26%
Can reduce LBW by 40%, infant
disability by 33% and infant
mortality by 50%
Can reduce maternal mortality
by 44%
Can reduce infant mortality by
24%
Can reduce child malnutrition
by 19%
Can reduce child stunting by
13%
Can reduce child malnutrition
by 43%
Can reduce child stunting by
2%
Nutrition and Consumption Plan
2000 - 2003
Allocation Rs 534 Million
Targets to be achieved
Deficiency
Baseline
2000
Vitamin A
40%
0
Iodine
40-60%
10%
65%
45%
15%
10%
LBW
25%
7%
Population Calorie
Intake (Less than 70%)
of RDA (2300 Cal)
34%
6%
PEM
39%
10%
Fe
Women
Children
Source: Planning Division Government of Pakistan. 2000.
Target
2003
Policies and Strategies to Improve Nutrition

By improving household income and food security
 Education levels of mothers
 Children feeding practices
 Nutrition education and investment in nutrition
 Health environment
 National nutrition surveillance and statistical system
 Biotechnology applications
 Communication between public and private sectors
 Good governance
 Political stability
Some points to ponder
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Good nutrition in early life pays dividends in childhood and in later
life.
Malnutrition adversely affects mental development, physical
development, productivity and span of working years, all of which
significantly influence the economic potential of man.
Poverty is closely correlated with under nutrition.
No progress in child health can be achieved unless under nutrition
among children is eliminated.
A malnourished nation cannot participate in economic development
effectively unless its nutritional problems are solved.
Low levels of education and poor health and nutrion status are
limiting Pakistan’s productivity and adversely affecting economic
growth and poverty reduction prospects.
Investment in nutrition reduces health care cost and the burden of
non-communicable diseases.
The country has not achieved normalcy in nutritional stability due to
poor nutrition planning and implementing national programmes.
Nutritional Interventions of Tawana
Pakistan Project
Nutritional Interventions
•
Deworming Drugs
• Noon Meal

Micronutrient Supplements
Including iron, iodine and
Vitamin A
Benefits To School Girls
• Improves Nutritional Status
• Prevents Infections and Nutritional
Deficiency Diseases
• Improves School Enrollment and
Performance
Tawana Pakistan Project: School Nutrition
Package for Girls
Objectives
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Improve nutritional status of school girls (5-12 years) through school
feeding programme, deworming and micronutrient supplements.
Increase enrollment and sustain attendance of girls and to reduce
gender gap in School Enrollment.
Create community awareness for healthy living through health and
nutrition education.
Beneficiaries
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Number of high poverty districts:
Number of girls (5-12 years):
Number of schools:
Communities in target villages:
29
530,000
5,300
5,300 (10.5 million)