Munawar presentation on nutrition situation in pakistan world health day lmc
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Transcript of 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)
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%
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