Pakistan has an exceptionally high level of child undernutrition, says a latest World Bank report which noted with concern that country’s stunting rate, 45 per cent, ranks worse than 124 out of 132 countries and its wasting rate, 11 per cent, ranks worse than 106 out of 130 countries
A report titled, “Child Undernutrition in Pakistan. What Do We Know”, written by Dhushyanth Raju Ritika D’Souza says Pakistan’s high level of child undernutrition may have produced sizeable economic costs, through the loss of human capital and increased health costs.
It finds that the districts with the highest child undernutrition rates are concentrated in Balochistan, Khyber Pakhtunkhwa and Sindh and that within Punjab, the southern districts tend to have higher child undernutrition rates than the northern districts.
The report notes that although caloric supply is roughly in line with the recommended caloric consumption level, the actual caloric consumption level for most households is below the recommended level. The typical diet of households is not sufficiently diverse, with most calories obtained from cereal consumption.
World Bank finds that, from 2000–01 to 2013–14, the cost of food increased sharply in Pakistan, particularly in the latter half of that period. Over the full period, food prices rose by 270 per cent, compared to a rise of 180 per cent in non-food prices. The poor nutrition status of the mother can harm the survival, health, growth and development of the child from pregnancy onward.
The report notes that evidence for Pakistan suggests that the use of reproductive, maternal, and child health services can improve child nutrition status. It especially mentions utilizing the Lady Health Worker (LHW) programme to have sizeable positive effects on health and nutrition outcomes.
Stunting status is measured by low height–for–age, reflects chronic undernutrition, due to inadequate food intake over the long term, or repeated or chronic illness. Wasting status is measured by low weight–for–height, is considered to reflect acute undernutrition due to a recent drop in food intake or recent acute illness. Underweight status, measured by low weight–for–age, is a hybrid measure of height–for–age and weight–for–height, and thus reflects both acute and chronic undernutrition.
It notes that Pakistan also registers critically poor outcomes in terms of the nutrition status of women, adolescent girls and micronutrient status of young children. The 2011 National Nutrition Survey (NNS) finds that 54 per cent of children below five years of age are deficient in vitamin A, 39 per cent are deficient in zinc, 40 per cent are deficient in vitamin D, 44 per cent are deficient in iron, and 62 per cent are anemic.
The survey also finds that 14 per cent of mothers are thin and 34 per cent are overweight and that 51 per cent of pregnant women are anemic, 46 per cent are deficient in vitamin A, 69 per cent are deficient in vitamin D, 48 per cent are deficient in zinc, and 59 per cent are deficient in calcium.
Based on 2013–14 national Household Integrated Economic Survey (HIES) data, World Bank finds that the average daily household caloric consumption per adult equivalent is 2,033 calories which is 13 per cent lower than the officially recommended level of 2,350 calories.
Using national Pakistan Social and Living Standards Measurement (PSLM) survey data from 2005–06 and 2007–08, it was found that depending on which quarterly period the data are from, between 15 percent to 20 percent of calories are from own-produced food, with between 33 per cent to 47 per cent of households consuming some own-produced food. It was found using 2005–06 data that, on average, 47 per cent of dairy and 34 per cent of wheat consumed by a rural household are from own production (the corresponding statistics are 14 per cent for meat, 2 per cent for fruit, and 4 per cent for vegetables).
Cereals are the main source of calories for Pakistani households. World Bank finds that, for the poorest households, 60 per cent of calories are from cereals, followed by 12 per cent from oils, and 10 per cent from sugar. The study also finds that the distribution of calories across food groups for the poorest households is similar for rural and urban areas, and that, compared to the richest households, the poorest households consume proportionately more calories from cereals and proportionately less from milk and yoghurt, meat and eggs, and fruit.
Food balance sheet statistics compiled by the Food and Agriculture Organization (FAO) indicates that Pakistan’s supply of daily calories per capita has fluctuated between 2,200 and 2,400 calories since the 1970s. However, caloric consumption appears to have declined over the recent past.
Based on national HIES data, World Bank finds that average daily household caloric consumption per adult equivalent declined by 9 per cent between 2001–02 and 2013– 14 (from 2,228 to 2,033 calories), even though average real household consumption expenditure per adult equivalent rose substantially over the period.
The report notes, Pakistani households have registered large gains in terms of the use of maternal and child health services. Between 1990–91 and 2012–13, the share of births for which mothers received antenatal care from a trained medical professional nearly tripled from 27 per cent to 73 per cent, the share of births for which mothers had four or more antenatal checkups increased from 14 per cent to 37 per cent. The share of births in hospitals increased from 13 per cent to 49 per cent, and the share of births attended by trained medical professionals rose from 35 per cent to 52 per cent.
The increase in the use of maternal and child health services in Pakistan may be related to their expanded availability, mainly through the community-based Lady Health Worker (LHW) program. The number of LHWs more than tripled from about 30,000 in 1996 to 110,000 in 2014.
The evidence for Pakistan suggests that the use of reproductive, maternal, and child health services can improve child nutrition status. The LHW programme is a major part of the public primary health system, and while the effects of LHWs on health-seeking behaviours and health outcomes are mixed and often small, evidence on interventions that attempt to improve their performance shows that LHWs can have sizeable positive effects on health and nutrition outcomes.