Malnutrition in Rural Sindh

There is no doubt that malnutrition is one of the biggest challenges facing most of the countries in the Global South. Many underdeveloped and developing countries have huge portions of their infant and female population suffering from various forms of malnutrition. According to the World Health Organization, malnutrition includes undernutrition, inadequate vitamins and or minerals, overweight, obesity, and diet-related diseases. Undernutrition is further divided into 4 forms: wasting, stunting, underweight, and deficiencies in vitamins and minerals. Undernutrition also is one of the leading reasons for high child morbidity and mortality ratios.

Globally nearly half of the annual deaths — about 2.5 million — “among children under the age of five are attributable to under-nutrition” (Bhutta, 2017). According to the National Nutrition Survey, 2018, four out of every 10 children, under 5 years of age, in Pakistan are stunted and around 17.7% suffer from wasting. In the same age group, around 28.9% of children are underweight and many are overweight — both forms pose great health risks. The National Nutrition Survey also shows that while the effect on male and female children is mostly equal, boys turn out to be more malnourished than girls.

The infographic above indicates the rate of prevalence of different forms of malnutrition amongst children in Pakistan. Courtesy: National Nutrition Survey, 2018.

According to research and various studies, malnutrition is a result of various contributing factors. Some of these factors are low birth weight, inadequate breastfeeding, inconsistent breastfeeding, lack of proper knowledge about nutrition and diet, inadequate to no maternal education, space between births, number of household members, number of bread-earners, food insecurity, lack of sanitation, infectious diseases, and lack of timely vaccinations. Studies have also shown that the first 100 days after birth play a crucial role in the mental and physical development and strengthening of a child. Failing to cater to a child’s needs in the first 100 days after the birth leads to several complications, resulting in stunting, undergrowth, overgrowth, and wasting.

Moreover, it is not just malnutrition in children that is a threat to human life. Malnutrition is also rampant among women, especially those women who are in their reproductive age. Rural areas tend to have food insecurity which leads to inadequate food and nutrition intake, resulting in iron deficiency and anaemic patients. This works as a positive feedback loop as fetal growth in malnourished women is relatively small, resulting in underweight newly-borns. Pakistan is also home to many myths. In many rural and urban areas, it is perceived that a grown-up’s fecal material is more dangerous than that of a child’s, which is not true. A child’s feces carry more germs and diseases which means that safe disposal of children’s feces should be prioritized, which is seldom done. According to the National Nutrition Survey report from 2018, only 38.5% of children’s last stools were disposed off safely.

In Pakistan, Sindh is one of the provinces with an alarming situation in terms of malnourished children. According to a report released by child rights advocacy group called Sparc in 2017, 57% of the children under the age of 5 are stunted in the province of Sindh. In Tharparkar, according to a compilation of the WHO, 45.9% of the children suffer from stunted growth and are prone to viral infections and diseases. Moreover, in a survey conducted by HANDS in collaboration with PDMA in the Tharparkar district, out of 627 children at least 269 had stunted growth and all of them fell between the ages of 0 and 5.

In 2016, Executive Director of the NGO Participatory Development Initiatives, Sikander Brohi, criticized the Sindh government and said that the government only spends one per cent of the total budget on nutrition. He also said that the provincial government spends most of the money on non-development projects and that the urban centers get more attention and budget than rural areas. He mentioned that health comes at the 4th position in the list of priorities and only 9.10% of the total budget is allocated to the entire health sector. In a seminar called Possibilities, Opportunities and Challenges for Implementation of Integrated Nutrition Strategy Sindh’, organized by the EU-WINS and Save the Children, the data showed that 53% of the children in Sindh suffer from vitamin A deficiency, 73% are anaemic, 42% are deficient in vitamin D and 38% have a Zinc deficiency. However, the Sindh government for the fiscal year 2020–21 has announced a 30% increase in the health budget, keeping the pandemic budget aside, and the provincial government aims to cater to the children and their mothers by providing them essential food supplies and adequate nutrition, keeping in mind the “first 100 days window” conception.

The incidence of Global Acute Malnutrition (GAM), a measurement of nutritional status, in Tharparkar, Sanghar, and Qamber-Shahdadkot is 22.7pc, 16pc, and 13.8pc, respectively. Despite Action Plans, committees, and budget allocation, malnutrition is still widely prevalent within the province of Sindh. The Accelerated Action Plan (AAP), a multi-sector plan of action prepared by the Sindh government for the reduction of stunting and malnutrition, aims to reduce the rate of malnourished cases from 45% to 15% by the year 2026. The nationwide plan is in alignment with Pakistan's Vision of 2025. As of now, there has been very less improvement. As per the National Nutrition Survey, the overall reduction rate of stunting is only 0.5%, which is too little to reduce malnutrition on a bigger scale. In the face of the current situation, a serious intervention is needed, as a large-scale reduction with baby steps looks like a long shot.