NATIONAL NUTRITION SURVEY 1985 – 87 PAKISTAN

1. Executive Summary
The Pakistan National Nutrition Survey 1985-87 providesinformation about the nutritional status of the nation with particular emphasis on at-risk groups - young children and their mothers. Similar studies conducted in 1965-66 (Nutrition Survey of West Pakistan) and 1976-77 (Micro-Nutrient Survey) and other smaller studies had indicated important nutritional problems, particularly Protein-energy malnutrition (PEM) and anemia. It appeared that inappropriate weaning practices were widespread, that breast-feeding was being increasingly compromised by that of the bottle and acute -infections, especially diarrhea were important causes of malnutrition. The current survey confirms these conclusions.
The National Nutrition Survey was a massive undertaking, which began in 1985 as a joint Federal and Provincial Government activity. The Nutrition Division, National Institute of Health was responsible for the survey, from planning to report. The fieldwork, done by Provincial Health Departments was completed in early 1987. The report was finalized 1n December 1988. This National Survey was conducted to indicate the extent, severity and location of malnutrition in the country. According to a sampling frame supplied by the Federal Bureau of Statistics, 8,360 randomly selected households, almost 60,000 individuals including 11,285 children under five years, 1,135 pregnant and 2,949 lactating mothers were examined. Anthropometry, selected clinical signs and hemoglobin tests were conducted on all household members; questions on feeding habits, quantitative food weighment and laboratory tests were done on all at-risk subjects and sub sample of others. The food intake study component of over 10,000 subjects, provided insights into several problems associated with malnutrition. Not only were amounts of foods and nutrients considered, but also qualitative information concerning the percentage of subjects eating types of foods. This enabled comparisons between results for different ages and biological groups. Extensive editing was performed on the anthropometric data to account for problems in bias and imprecision. We consider these estimates of malnutrition prevalences are a reasonable reflection of nutritional status.
This report indicates that:
Protein-energy malnutrition and anemia continues as a serious, widespread problem throughout the country. Its scope and severity are essentially unchanged over the last ten years. According to WHO criteria for low weight-for-age, 52% of young children are normal. 48% are malnourished within which 10% are severely so. Anemia occurs in 65% of young children and in 45% of pregnant/lactating mothers. Although the criteria of weight-for-age is
more commonly used, detailed analysis also focuses on low height-for-age (stunting: an index of chronic malnutrition) and low weight-for- height (wasting: an index of acute malnutrition).
Protein-energy malnutrition is universal. It affects a11 groups within the nation. It occurs equally in boys and girls. There is little difference between urban and rural areas and cities, and between low and middle socio-economic status areas within cities. As expected, however, upper socio-economic status areas within cities had less malnutrition. Infants, particularly those under six months of age, show a relatively high prevalence of acute malnutrition, compared with other age groups. This unexpected finding suggests a critical age group that needs priority attention. According to age, general malnutrition reaches peak prevalence in the second year of life. Among pregnant and lactating mothers, anemia increases with age, from 38% of mothers aged 20-24 to 66% of mothers over 45. Of the 4,085 pregnant and lactating mothers surveyed, 34% are underweight for height (Body Mass Index under 19) and 6% perhaps severely so (Body Mass Index under 16). Low weight and height are more commonly among uneducated mothers. Breast-feeding information derived from mothers' recall indicated that 5% of mothers never breast-fed and a further 18% introduced bottle-feeding early on. These results tend to confirm other studies; the majority (68%) of young children aged 7-9 months do not consume any food (apart from milk) even though a variety of nutritious foods are readily available in the same household. Calorie deficiency is a much more serious problem than protein deficiency in young children as evidenced by higher prevalence rates for nutrient intakes. Iron deficiency is very common in pregnant women and young children. Because of the design of this survey the expected high rates of goiter indicating iodine deficiency in certain parts of the country could not be identified.
1.1. SUMMARY OF FINDINGS
I. Extent of malnutrition in vulnerable groups at National level Children under five years of age
" 48% are malnourished (low weight-for-age) 10% are seriously malnourished (very low weight-for-age)
* 46% have chronic malnutrition (stunting: low height-for-age) 15% have acute malnutrition (wasting: low weight-for-height) Infants have a higher rate of acute malnutrition (20%)
* 65% are anemic (under 11 gm% hemoglobin). 28% are severely anemic (under 9 gm%).
Pregnant/lactating mothers '*,
* 34% are underweight for height (BMI under 19) 6% are severely underweight (BMI under 16)
* 30% are below 150 cm in height and 6% below 145 cm.
* 45% are anemic (under 11gm% hemoglobin)
10% are severely anemic (under 9 gm%). Anemia occurs in 66% of mothers aged over 45 years.
II. Distribution of malnutrition
* Protein-calorie malnutrition affects all areas of the country.
* There is little difference in the prevalence of malnutrition between boys and girls.
* There is less chronic but more acute malnutrition in urban areas; this affects the children of lower socio-economic status more.
* Malnutrition is most prevalent in Balochistan, where only 27% of children are normally nourished. In NWFP normal children are 31%, in Sindh 36%, and in Punjab 49%.
III. Feeding Practices (recall information)
* 5% of mothers report never breast-feeding.
* 18% report using bottle-feeding as well as breast-feeding.
* The most common reasons for stopping breast-feeding are that the child is big, and pregnancy.
IV. Food intake (observation and weighing for one day)
* Breast-feeding is practiced almost universally throughout the country (90% from 1-5 months of age), although less in cities. The average duration of breast-feeding is approximately 15-18 months. The adequacy of breast-feeding is another matter.
* Bottle-feeding occurs in 13% of infants aged 1-3 months, rises to a peak of 24% at 7-9 months and continues to about 20% during most of the second year of life.
* Most children (68%) aged 7-9 months do not consume food apart from milk. Even by 12-17 months 30-50% eat no food.
* Young children do not eat readily available food (cereals, pulses, meat, vegetables) that is
eaten by other members of the same household.
* Caloric deficiency (as shown by nutrient intake) was far more serious than protein deficiency in relation to Protein-energy Malnutrition in young children.
* Iron deficiency is extremely high -in pregnant/lactating women as well as in very young children. This confirms the high levels of anemia in these groups.