Malnutrition is a pathological condition resulting from eating a diet in which nutrients are either not enough or are too much such that the physical function of an individual is impaired to the point where he or she can no longer maintain natural bodily capacities such as growth, pregnancy, learning abilities, physical work and resisting or recovering from disease. The term covers a range of problems from being dangerously thin (underweight) or too short (stunting) for ones age to being deficient in vitamins and minerals or being too fat. Malnutrition is due to of lack of enough food or the right sort of food. Disease is often a factor, either as a result or contributing cause. Even if people get enough to eat, they will become malnourished if their diet does not provide the proper amounts of micronutrients – vitamins and minerals – to meet daily nutritional requirements. Malnutrition is the largest single contributor to disease, according to the UNs Standing Committee on Nutrition (SCN).
Children and women are usually affected by Malnutrition. According to SCNs World Nutrition Situation 5th report, 147 million preschoolers are affected by it and it cause reduced physical and mental retardation. Iodine deficiency is greatest cause of mental retardation and brain damage. In 2001, it was noted that malnutrition caused 54% deaths in children living in developing countries. The World Health Organization through the Millennium Development Goal 4 has recognized that improved nutrition is crucial in reducing the under-5 years mortality, especially in the developing countries.
Laying its special emphasis in our part of the world, the percentage of malnourished children is highest in Asia with 70% of undernourished children living in this part of the world. Micronutrient deficiency among children is also high and has worsened considerably since 2001. More than half of the children in Pakistan suffer from vitamin A deficiency. In South Asia, one out of two preschoolers is underweight and has stunted growth. In Pakistan,33.03% (CI= 27.96-38.54)of children under the age of 5 are underweight, 53.38% of the children are stunted and wasting has been reported in 11.52% of the children, which clearly shows that the nutritional status in this country is poor. Goiter caused by iodine deficiency is also common with the highest cases reported in Pakistan, India and parts of Indonesia. According to National Nutrition Survey, In Pakistan there has been improvement in rates of iodine deficiency from 42 per cent to 12 per cent among children between the ages of 6 and 12.
To solve the problems causing malnutrition among Pakistani children, the following measures are suggested: Various methods like the use of fertilizers would give a better crop. Policies should be made by the government to provide food security to the masses. Educational programs should be planned that elucidate the importance of various components in a childs diet and also inform people about cheaper food alternatives that can provide them with vital nutrients. Controlling the growth of population and providing family planning guidance will lead to more food availability. By increasing the cultivated areas agriculture production will increase due to which more and cheaper food will be available and also for increasing cultivated areas more labor will be required so many poor families will get income from that which in turn decrease poverty.
SUMMARY OF PAKISTAN
In Pakistan, the nutritional status of children under five years of age is extremely poor. At a national level almost 40% of these children are underweight. Over half the children are affected by Vitamin A deficiency and stunting, and about 9% by wasting. A positive relationship exists between the age of the child and the prevalence rates of stunting and underweight. There are significant provincial variations in malnutrition rates in Pakistan, whereas no differences in malnutrition rates are apparent between sexes. The prevalence of stunting appears to be associated with the overall level of development of the provinces, being lowest in Punjab and highest in Balochistan, the least developed province. According to NNS 2011, stunting in Punjab is 39% while in Balochistan is 52%.
The anthropometric deficits are systematically higher in rural areas probably due to the lower socio-economic status and to very poor access to basic health services. Prevalence of stunting is 9 percentage points higher in rural areas compared to urban locations.
According to the nation-wide food consumption surveys conducted in Pakistan, the average daily per caput energy intake covered the daily requirements in the periods 1984-85 and 1987-88. Unfortunately, since no recent nation-wide food consumption surveys are available, no information on the adequacy of present food consumption can be given.
In the Pakistani diet cereals remain the main staple food providing 62% of total energy. Compared to other Asian countries, the level of milk consumption is significant in Pakistan, whereas the consumption of fruits and vegetables, fish and meat remains very low. The consumption of fruit and fresh vegetables, which are highly dependent on local seasonal availability, is also limited by the lack of organized marketing facilities throughout the country. Fluctuations in the availability of these important foods are likely to be one of the factors responsible for the micronutrient deficiency disorders observed in Pakistan.
Food consumption is just one of the multiple factors which interact and have an impact on the nutritional status of the overall population. Other important influences include morbidity, poor coverage of health infrastructures and socio-economic factors.
Since Pakistans independence (1947), the provision of health infrastructures has improved over time but remains inadequate particularly in rural areas. The under-five mortality rate, an important index of health and nutritional status of a community, is high by international standards: 137 for 1,000 births. A large number of infectious diseases such as respiratory and intestinal infections remain responsible for up to 50% of deaths of children under five, with malnutrition being an aggravating factor especially in the most populated areas.
Malnutrition prevalence – weight for age (% of children) in Pakistan
Malnutrition prevalence; weight for age (% of children) in Pakistan was last measured at 30.90 in 2011, according to the World Bank. Prevalence of child malnutrition is the percentage of children under age 5 whose weight for age is more than two standard deviations below the median for the international reference population ages 0-59 months. By the National Nutrition Survey Provincial wise underweight percentage, Punjab has low ratio of underweight children as compare to the less developed provinces like Balochistan. Provincial wise under-weight percentage is given below in table.
PROVINCIAL TRENDS IN ANTHROPOMETRIC INDICATORS (UNDER-WEIGHT %AGE)
• Causes of Malnutrition
Major causes of malnutrition include poverty and food prices, dietary practices and less agricultural productivity, with many individual cases being a mixture of several factors. Clinical malnutrition, such as in cachexia, is a major burden also in developed countries. Various scales of analysis also have to be considered in order to determine the sociopolitical causes of malnutrition. For example, the population of a community may be at risk if the area lacks health-related services, but on a smaller scale certain households or individuals may be at even higher risk due to differences in income levels, access to land, or levels of education.
• Diseases
• Under-nutrition
• Over-nutrition
• Poverty and food prices
• Agricultural productivity
PREVENTION
• Food security
The effort to bring modern agricultural techniques to meet the challenges of world food security in respect of increasing population.
• Gene Revolution
To improve food security and nutrition issue agriculture biotechnology can play an important role. By genetic engineering we can not only produce disease and drought resistant crops but also produce nutritious beneficial crops like protein rich wheat and millet and “golden rice” which contain Vitamin A.
• Breastfeeding
Breastfeeding in the first two years and exclusive breastfeeding in the first six months could save 1.3 million childrens lives.
• School Food Program
By providing nutritious food to children at school level is very good incentive. International organizations, NGOs and Government should start such programs at school level to overcome the malnutrition issue. It is also an incentive for children to go to school and perform better.
• Fortified foods
Manufacturers are trying to fortify everyday foods with micronutrients that can be sold to consumers such as wheat flour for Beladi bread in Egypt or fish sauce in Vietnam and the iodization of salt.
For example, flour has been fortified with iron, zinc, folic acid and other B vitamins such as thiamine, riboflavin,niacin and vitamin B12.
• Food sovereignty
One suggested policy framework to resolve access issues is termed food sovereignty-the right of peoples to define their own food, agriculture, livestock, and fisheries systems, in contrast to having food largely subjected to international market forces.
• Health facilities
Another possible long term solution would be to increase access to health facilities to rural parts of the world.
The authors are from Institute of Soil and Environmental Sciences and Department of Agronomy, Faculty of Agriculture, University of Agriculture, Faisalabad. They can be reached at moeenijaz1@gmail.com