An Overview of Food And Nutrition Situation An Overview of Food And Nutrition Situation in Pakistanin Pakistan

Freedom from hunger and malnutrition is a basic human Freedom from hunger and malnutrition is a basic human right. Nutrition has been expressed as a right in various right. Nutrition has been expressed as a right in various international declarations and human rights instruments international declarations and human rights instruments from time to time. According to UN Article 24, states are from time to time. According to UN Article 24, states are

mandated to provide medical assistance and health care to mandated to provide medical assistance and health care to all children, combat disease and malnutrition through all children, combat disease and malnutrition through

provision of adequate nutritious foods, safe drinking water provision of adequate nutritious foods, safe drinking water and adequate sanitation and provide families with and adequate sanitation and provide families with

information about the advantages of breastinformation about the advantages of breast

feeding.feeding.

Intake of Food Intake of Food byby Food Groups Food GroupsFood groups Per person per day

(gm)Distribution of food among Adult Males (%)

Urban Rural

Total Cereals 426 99 99

Wheat

362

Rice 38

Other Cereals 26

Fat and oils 39 98 96

Sugar 80

Roots 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 Dietary Pattern of Adult Males (%) in Different ProvincesDifferent 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 variousAvailability of Dietary Energy from variousFood GroupsFood Groups

Food GroupsAvailable Calories per head per day

1990 2000 Desirable

Total Cereals 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

Total Calories2392 2452

Average Requirements2310 2310

Calories % Requirement103.5 106.1

Sources: FAO (1990, 2000) food Balance Sheet. RomePakistan is not a food insecure country.

Quantity and Nutritional Quality of Diets Quantity and Nutritional Quality of Diets Available During 1990 & 2000Available During 1990 & 2000

Indicators Per capita Per day Criteria for balance diet 1990 2000

Quantity

Calories 2392 2452Proteins (g) 58.4 62.5Fats (g) 58.5 64.2

Quality

Percent Calories from:Protein 9.8 10.2 10.-15Carbohydrates 68.2 66.2 55-70Fats 22.0 23.6 20-30

Causes of Malnutrition Causes of Malnutrition

PovertyPoverty Shortage of foodShortage of food Maldistribution of FoodMaldistribution of Food Infections Infections IgnoranceIgnorance

Food Insecurity Profile – District WiseFood Insecurity Profile – District Wise

Calories/Capita/day of all food Calories/Capita/day of all food (Consumption Vs. Production)(Consumption Vs. Production)

Punjab

NWFP SindhBalochistan

N.A AJK FATA

High Insecu

re4 20 3 15 4 7 7

Medium

Insecure

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 StatusNutritional StatusNutrient Intake of School Girls (6-15 Years)

% of RDA

Calories 86%Protein 118Iron 67

Prevalence of Malnutrition (Under Five)

Low birth weight 25-34% (1.42 -1.94 million)Under Weight 40% (9.5 million)

(Low Weight for Age)Stunting 50% (12 million)

(Low Height for Age)Wasting 9% (12 million)

(Low weight for Height)Anemia 51%

(Iron Deficiency)Goitre

(Iodine Deficiency) 77%School age children

Bitot’s Spot(Vitamin A Deficiency) 5.8%

Incidence of Malnutrition (Under five) in Incidence of Malnutrition (Under five) in PakistanPakistan

MalnutritionMalnutrition NHSNHS NNSNNS FAO___________ FAO___________ IndicatorsIndicators 1990-941990-94 2000-02 1990 1999-2000 2000-02 1990 1999-2000________________________________________________________________________________________________________________________________________

UnderweightUnderweight 39%39% 38%38%StuntingStunting 35%35% 37%37% 35%35% 50%50%WastingWasting 14%14% 13%13%________________________________________________________________________________________________________________________________________

Child Mortality in PakistanChild Mortality in Pakistan

Mortality/1000 live birthsMortality/1000 live births 19901990 19991999Infant mortalityInfant mortality 104104 9090Under five mortality rateUnder five mortality rate 138138 126126________________________________________________________________________________________________________________________________________

Cost of Malnutrition Cost of Malnutrition

Malnutrition costs the country Rs 200 billion every year equivalent of more than 5% ofMalnutrition costs the country Rs 200 billion every year equivalent of more than 5% ofGNP in lost lives, disability and productivity. GNP in lost lives, disability and productivity.

Breast Feeding PracticesBreast Feeding Practices

Duration UNICEF NNS 1990 2000 2000 - 2

0-3 months 87% 16% 62%6-9 months 74% 31% 35%

Other Indicators Related To Child NutritionOther Indicators Related To Child Nutrition Infant mortality rate 90 per 1000 live birthsUnder five mortality rate 126 per 1000 live birthsAdult female literacy rate 24%Female literacy as % of males 48%Number of children out of school 8.2 millionNumber of girls out of school 5.9 millionPrimary school enrollment 46%Middle school enrollment 16%Secondary school enrollment 52%Drop out of rural girls at primary schoolLevel 75%Rural girls (12 year old) continue school 3%Rural boys (12 year old) continued school 18%Coefficient of educational efficiency 68%No of Government primary schoolWithout water and sanitation facilities 90%No of primary school without shelter And boundary wall 50%

Quality of LifeQuality of Life

PovertyPoverty% population below poverty line% population below poverty line 3434% population below $ 1 a day% population below $ 1 a day 3131% population below $ 2 a day% population below $ 2 a day 8585New born weighted at birth (%)New born weighted at birth (%) 1212Babies registered at birth (%)Babies registered at birth (%) 3030Breast feeding practicesBreast feeding practices

0-3 months (%)0-3 months (%) 16166-9 months (%)6-9 months (%) 3131

Access to sanitationAccess to sanitation 3030(% of population)(% of population)

Access to improved water sourceAccess to improved water source 6060(% of population)(% of population)

Parasitic InfectionsParasitic Infections 6060(% of population)(% of population)

Consumption of iodized saltConsumption of iodized salt 1919

(% of households)(% of households)Vitamin A supplementationVitamin A supplementation 11

(% coverage of pre-school children)(% coverage of pre-school children)Physicians (Per 1000 people)Physicians (Per 1000 people) 0.60.6Health Expenditure (% of GDP)Health Expenditure (% of GDP) 0.90.9Education Expenditure (% of GDP)Education Expenditure (% of GDP) 2.72.7 Economic cost of MalnutritionEconomic cost of Malnutrition 200200

(Billion rupees per year)(Billion rupees per year) (5% of GDP)(5% of GDP)Life ExpectancyLife Expectancy MalesMales 61 years61 years

FemalesFemales 63 years63 years

REPRODUCTIVE HEALTHREPRODUCTIVE HEALTHFemale Population Female Population 48.2 48.2

(% of Total)(% of Total)

Total Fertility Total Fertility 4.84.8(Births per Women) (Births per Women)

Adolescent Fertility RateAdolescent Fertility Rate 100100

(Births per 1000 Women)(Births per 1000 Women) Contraceptive Prevalence RateContraceptive Prevalence Rate 24 24

(% of Women) (% of Women) Pregnant Women Receiving Prenatal CarePregnant Women Receiving Prenatal Care 2727

Births Attended By Skilled Health StaffBirths Attended By Skilled Health Staff 1919 (% of Total) (% of Total)

Prevalence Of Anemia Prevalence Of Anemia 3737

(% of Pregnant Women) (% of Pregnant Women) Maternal Mortality Rate Maternal Mortality Rate 340/100,000 340/100,000

(600(600,,000/ year)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%

_________________________________________________

* 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.

Indicators for Assessing and Monitoring Nutritional Indicators for Assessing and Monitoring Nutritional ProblemsProblems Food CrisesFood Crises

• Production patternsProduction patterns• market pricesmarket prices• Food stocksFood stocks• Fall in body weightsFall in body weights

Protein – energy malnutritionProtein – energy malnutrition • Children’s anthropometry (weight for height for age, weight for Children’s anthropometry (weight for height for age, weight for age, height for weight)age, height for weight)• Children's’ growthChildren's’ growth• Infectious disease rateInfectious disease rate• Food intake relative to needFood intake relative to need• Body mass indexBody mass index

Micronutrient deficienciesMicronutrient deficiencies• Iron deficiency : rates of anemiaIron deficiency : rates of anemia• Vitamin A deficiency: night blindness/xerophthalmiaVitamin A deficiency: night blindness/xerophthalmia• Iodine deficiency: goiter, cretinismIodine deficiency: goiter, cretinism

Household food security Household food security • Employment levelsEmployment levels• Market pricesMarket prices• Changes in real income and purchasing powerChanges in real income and purchasing power• Dietary energy supplyDietary energy supply

Caring capacityCaring capacity• Maternal education Maternal education • Maternal employment, public expenditure Maternal employment, public expenditure • Literacy ratesLiteracy rates• Breast feeding (duration and percentage)Breast feeding (duration and percentage)

NUTRITIONAL CHALLANGESNUTRITIONAL CHALLANGES

Poor Household Food SecurityPoor Household Food Security Low Birth WeightLow Birth Weight Child Feeding MalpracticesChild Feeding Malpractices Childhood Under-Nutrition (PCM)Childhood Under-Nutrition (PCM) Micronutrient DeficienciesMicronutrient Deficiencies

(Vitamin A, Iodine, Iron, Zinc)(Vitamin A, Iodine, Iron, Zinc)

Interventions for Improving Nutrition StatusInterventions for Improving Nutrition StatusInterventionsInterventions BenefitsBenefits

Breast Feeding Breast Feeding Improved breast feeding practice Improved breast feeding practice Can reduce child Can reduce child malnutrition and reduced bottle feeding malnutrition and reduced bottle feeding

mortality and mortality and can save more can save more childrenchildren

Improved Food IntakeImproved Food IntakePer capita food availability Can reduce child malnutrition Per capita food availability Can reduce child malnutrition

by 26%by 26%During pregnancy Can reduce LBW by 40%, During pregnancy Can reduce LBW by 40%, infant infant disability by 33% and infantdisability by 33% and infant

mortality by 50%mortality by 50%Vitamin A SupplementationVitamin A Supplementation

During Pregnancy Can reduce maternal During Pregnancy Can reduce maternal mortality mortality by 44%by 44%To new born in the first 48 hours Can reduce infant mortality by To new born in the first 48 hours Can reduce infant mortality by

24%24%Improved Health EnvironmentImproved Health Environment Can reduce child Can reduce child

malnutrition malnutrition by by 19%19%

Improved Education Level Of MothersImproved Education Level Of Mothers Primary School Can reduce child stunting by Primary School Can reduce child stunting by

13% 13% Secondary School Can reduce child malnutrition Secondary School Can reduce child malnutrition

by 43%by 43%IncomeIncomeIncreased per capita income by 10% Increased per capita income by 10% Can reduce child stunting Can reduce child stunting

by by 2%2%

Nutrition and Consumption PlanNutrition and Consumption Plan2000 - 20032000 - 2003

Allocation Rs 534 MillionAllocation Rs 534 Million

Targets to be achieved Targets to be achieved BaselineBaseline Target Target

DeficiencyDeficiency 20002000 20032003

Vitamin AVitamin A 40%40% 00

IodineIodine 40-60%40-60% 10%10%

FeFe WomenWomen 65%65% 15%15%ChildrenChildren 45%45% 10%10%

LBWLBW 25%25% 7%7%

Population CaloriePopulation CalorieIntake (Less than 70%)Intake (Less than 70%) 34%34% 6%6%of RDA (2300 Cal)of RDA (2300 Cal)

PEMPEM 39%39% 10%10%

Source: Planning Division Government of Pakistan. 2000.Source: Planning Division Government of Pakistan. 2000.

Policies and Strategies to Improve NutritionPolicies and Strategies to Improve Nutrition

By improving household income and food securityBy improving household income and food security Education levels of mothersEducation levels of mothers Children feeding practicesChildren feeding practices Nutrition education and investment in nutrition Nutrition education and investment in nutrition Health environmentHealth environment National nutrition surveillance and statistical systemNational nutrition surveillance and statistical system Biotechnology applicationsBiotechnology applications Communication between public and private sectorsCommunication between public and private sectors Good governanceGood governance Political stabilityPolitical stability

Some points to ponderSome points to ponder Good nutrition in early life pays dividends in childhood and in later Good nutrition in early life pays dividends in childhood and in later

life.life. Malnutrition adversely affects mental development, physical Malnutrition adversely affects mental development, physical

development, productivity and span of working years, all of which development, productivity and span of working years, all of which significantly influence the economic potential of man. significantly influence the economic potential of man.

Poverty is closely correlated with under nutrition. Poverty is closely correlated with under nutrition. No progress in child health can be achieved unless under nutrition No progress in child health can be achieved unless under nutrition

among children is eliminated. among children is eliminated. A malnourished nation cannot participate in economic development A malnourished nation cannot participate in economic development

effectively unless its nutritional problems are solved. effectively unless its nutritional problems are solved. Low levels of education and poor health and nutrion status are Low levels of education and poor health and nutrion status are

limiting Pakistan’s productivity and adversely affecting economic limiting Pakistan’s productivity and adversely affecting economic growth and poverty reduction prospects.growth and poverty reduction prospects.

Investment in nutrition reduces health care cost and the burden of Investment in nutrition reduces health care cost and the burden of non-communicable diseases. non-communicable diseases.

The country has not achieved normalcy in nutritional stability due to The country has not achieved normalcy in nutritional stability due to poor nutrition planning and implementing national programmes.poor nutrition planning and implementing national programmes.

Nutritional Interventions of Tawana Nutritional Interventions of Tawana Pakistan ProjectPakistan Project

Nutritional Interventions

• Deworming Drugs

• Noon Meal

Micronutrient Supplements Including iron, iodine and Vitamin A

• Improves Nutritional Status• Prevents Infections and Nutritional Deficiency Diseases • Improves School Enrollment and Performance

Benefits To School Girls

Tawana Pakistan Project: School Nutrition Tawana Pakistan Project: School Nutrition Package for GirlsPackage for Girls

Objectives Objectives Improve nutritional status of school girlsImprove nutritional status of school girls (5-12 years) through school (5-12 years) through school

feeding programme, deworming and micronutrient supplements.feeding programme, deworming and micronutrient supplements. Increase enrollment and sustain attendance of girls and to reduce Increase enrollment and sustain attendance of girls and to reduce

gender gap in School Enrollment.gender gap in School Enrollment. Create community awareness for healthy living through health and Create community awareness for healthy living through health and

nutrition education.nutrition education.

BeneficiariesBeneficiaries Number of high poverty districts:Number of high poverty districts: 2929 Number of girls (5-12 years):Number of girls (5-12 years): 530,000530,000 Number of schools:Number of schools: 5,3005,300 Communities in target villages:Communities in target villages: 5,300 (10.5 million)5,300 (10.5 million)