Munawar presentation on nutrition situation in pakistan world health day lmc

1

Food Security & Nutrition Situation In Pakistan

Munawar HussainProgram Manager Food FortificationGlobal Alliance for Improved Nutrition (GAIN

2

What is Food Security?

When all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and

food preferences for an active and healthy life.Source: according to World Food Summit

FOOD SECURITY

Avai

labi

lity

of

nutr

itiou

s fo

od

Food

Acc

ess

Stab

ility

Food

Util

izatio

n

3

Food Security in Pakistan

Pakistan Urban Rural0

10

20

30

40

50

60

70

28.4 26.5 29.2

19.817.7

20.7

9.88.2

10.5Food Insecure with hunger (Sever)

Food Insecure with hunger (moderate)

Food Insecure without hunger

4

Food Security

• Food Insecurity principally connected to o Low productiono Low socio-economic statuso Increasing prices of foodo Geographic hurdles and distribution

• Low income families are more prone to food insecurity

• The main determinant of food insecurity is malnutrition

5

Malnutrition - A World Health Dilemma

Malnutrition is a global problem characteristic with macro and micronutrients deficiencies.

Iron, iodine, Zinc, Vitamin A and Folic acid are the major micronutrient deficiencies

Impact huge economic losses by High mortality of women and children Reduced cognitive development in children

6

Why Malnutrition Matters?

Pneumonia 15%

Injuries, 3%

Other, 19%

Neonatal 42%

HIV/AIDS 1%

Diarrhoea 19%

Measles 1%

Malaria1%

45% attributable to

Under

nutrition

Globally 45% of under-five deaths are attributable to under nutrition

7

Why Malnutrition Matters?

Costly inefficiencies (e.g. illness, deaths)

Direct links: Decreased physical

productivity

Indirect links: impaired cognitive

development, schooling and productivity

Overall loss to the

economy of 3% of GDP

annually

Bigger than energy crises (2% of GDP)

8

South Asia a Nightmare for Nutrition

9

Stunting

A child is too short for his/her age

“Chronic” malnutrition, accumulated over long period of time

Generally occurs before age 2 y and is largely irreversible

Causes: poor nutrition for mothers during pregnancy, too few calories, poor quality of food (e.g. micronutrients), repeated infections (e.g. diarrhoea, malaria), poor feeding practices (e.g. not feeding colostrum)

44% of children under five are stunted in Pakistan

10

Stunting-Regional Comparison

Pakistan India Nepal Bangladesh Sri Lanka0

10

20

30

40

50

60

4448

45 43

17

11

Malnutrition and Food Insecurity

food secure food insecure without hunger

food insecure with moderate to severe

hunger

05

1015202530354045

25

32

42

% o

f you

ng c

hild

ren

stun

ted

The worse the food insecurity, the higher the child malnutrition

12

Wasting

A child who has a weight that is too low for his/her height

It is usually the result of acute significant food shortage and/or severe disease

Wasted children, especially severely wasted children are more likely to die

15% of children under five years in Pakistan are wasted – an “EMERGENCY”

13

Micronutrient Deficiencies

Affect mainly women and childrendue to poor quality of diet or depletion due to losses (e.g. infections)Main deficiencies:

IodineVitamin AIronFolic acidZinc

Also called HIDDEN HUNGER – often invisible

14

The Ugly Face of “Hidden Hunger”

Vitamin A Deficiency Iodine Deficiency Zinc Deficiency

Iron Deficiency

Folic

Acid

Def

icien

cy

15

Maternal Anemia

Source: NNS 2011Pakist

anUrb

anRural

PunjabSin

dhKPK

Baluchist

anAJK GB

0

10

20

30

40

50

60

70

No Pregnant Women

Pregnant Women

16

Anemia - Children Under Five Years of Age

Source: NNS 2011

Pakistan Urban Rural Punjab Sindh KPK Baluchistan AJK GB0

10

20

30

40

50

60

70

80

61.9 62.9 61.4 60.3

72.5

47.3

56.8

4641

17

Vitamin A Deficiency – Pregnant Mothers

Source: NNS 2011

Pakistan

Urban

Rural

PunjabSin

dhKPK

Baluchist

anAJK GB

0

10

20

30

40

50

60

70

80

90

Moderate (0.35 - 0.70 µmol/L)

Severe (<0.35 µmol/L

18

Vitamin A Deficiency – Children

Source: NNS 2011

Pakistan

Urban

Rural

PunjabSin

dhKPK

Baluchist

anAJK GB

0

10

20

30

40

50

60

70

80

Moderate (0.35 - 0.70 µmol/L)

Severe (<0.35 µmol/L

19

Zinc Deficiency - Mothers

Source: NNS 2011Pakistan Urban Rural Punjab Sindh KPK Baluchistan AJK GB0

20

40

60

80

100

120

47.6 47.4 47.7 47.3 44.552.6

43.6

95.8

54.8

20

Zinc Deficiency - Children

Pakistan Urban Rural Punjab Sindh KPK Baluchistan AJK GB0

5

10

15

20

25

30

35

40

45

50

39.2 39.3 39.1 38.4 38.6

45.4

39.5

47.2

32.6

Source: NNS 2011

21

Vitamin D Deficiency – Pregnant Mothers

Source: NNS 2011Pakist

anUrb

anRural

PunjabSin

dhKPK

Baluchist

anAJK GB

0

10

20

30

40

50

60

70

80

90

Deficiency (8.0 - 20.0 ng/mL

Severe de-ficiency (<8.0 ng/mL)

22

Vitamin D Deficiency – Children

Source: NNS 2011

Pakistan

Urban

Rural

PunjabSin

dhKPK

Baluchist

anAJK GB

0

5

10

15

20

25

30

35

40

45

50

Deficiency (8.0 - 20.0 ng/mL

Severe de-ficiency (<8.0 ng/mL)

23

Pakistan’s Progress on Malnutrition

Indicator NNS 2001-02

NNS 2011

1. Wasting % (Low Weight for Height) 12% 15%

2. Stunting% (Low Height for Age) 31% 44%

3. Under Weight% (Low Weight for Age) 42% 32%

4. Anemia (Children) 51% 62%

5. Anemia (Pregnant women) 29% 51%

6. Iodine Deficiency (Children) 63% 36%

7. Iodine Deficiency (Women) 76% 36%

8. Vitamin A Def (Children) 13% 54%

9. Vitamin A Def (Non-pregnant women) 6% 42%

24

Addressing Food Insecurity

Micronutrient Malnutrition

25

Addressing Food Insecurity

• Improve food availability and access• Ensure food safety and quality control• Adopt innovative techniques to improve

nutritional status and awareness• Improve food utilization at household level • Develop early warning and emergency

management system• Develop institutional and legal framework, and

financing mechanism

26

Addressing Malnutrition

Nutrition

Agriculture

Education

Food

WASH

Health

Social Protection

Addressing Malnutrition is not a stand alone subject. It needs Multi-sectoral approach

27

Addressing Micronutrient Malnutrition

Food FortificationDietary DiversificationSupplementation

Food fortification is safe and cost-effective intervention for the prevention of micronutrient deficiencies and has been widely practiced in developed countries for well over a century

28

Why Fortification?

Could target population at largeTechnology - simple and well establishedGlobal success history of addressing

deficiencies of micronutrientsEconomical - very cost-effectiveNo need to change dietary habits of targeted

populationFortification vehicles are easily accessible

29

Top 10 Investments for advancing global welfare

1 Micronutrient supplements - Malnutrition2 The Doha development agenda - Trade3 Micronutrient fortification - Malnutrition4 Expanded immunization coverage for children - Diseases5 Agricultural R&D on micronutrients - Malnutrition6 Deworming and nutrition programs at school - Malnutrition7 Lowering the price of schooling - Education8 Increase and improve girls’ schooling - Women9 Community-based nutrition promotion - Malnutrition10 Provide support for women’s reproductive role - Women

Copenhagen Consensus

30

Fortification - Key Success Factors

Political commitment and supportIndustry supportAdequate legislationConsumer acceptanceNo cultural or other objectionAvailability of micronutrients and

fortification equipment/ dossifiers Economically sustainable interventions

31

Fortification Programs in Pakistan

Universal Salt IodizationOil and fats fortification with Vitamin A & DWheat Flour Fortification with iron and folic

acidHome based fortification of multi-

micronutrients

32

Universal Salt Iodization

Started in early 90s with the support of UNICEF Made some progress but could not achieve

desired results due to rumors associated. Revitalized towards end of last decade and

made good progress Supported by MI, WFP, GAIN and UNICEF

partnership Iodine deficiency reduced from 63% to 36% in

children and 76% to 36% in mothers (NNS 2011) 31% population have no access to iodized salt Sustainability of program is still a challenge.

33

Wheat Flour Fortification

National Wheat Flour Fortification Program started in 2007 with the support of GAIN

Over 200 flour mills started producing fortified wheat flour

More than 12.7 M people got access to fortified wheat flour

Program suspended in 2011 after 18th constitutional amendment.

GAIN agreed to support Punjab Government toward end of 2013 to restart the program.

34

Wheat Flour Fortification

Program with market based approaches making good progress.

Mandatory fortification approved in Punjab effective from Sept 2015.

30 flour mills to start voluntary fortification in first phase

Market based supply of micronutrient and its availability

The future expansion to entire country based on lesson learnt.

35

Oil and Ghee Fortification

Fortification mandated with Vitamin A under pure food rules 1965

Poor regulatory monitoring and technical capacity of the industry are the major challenges

Punjab Food Authority Act 2011 repealed existing regulatory regime in the largest province of Pakistan

36

Challenges to Food Fortification

Common result based framework among stakeholders.

Commitment and coordination among stakeholders

Inadequate regulatory regime Availability of micronutrients in market Harmonization of standards of fortified foods Consumer awareness

37

Recommendations – Food Fortification

Active and effective National Fortification Alliance with empowered provincial chapters

Open market based availability of micronutrients Taxes and duties exemption by government on

the import of micronutrients. Effective legislation for mandatory fortification in

all provinces and regions Consumer awareness raising programs Capacity building of regulatory bodies Technical capacity building of industry

38

Thank you