An Overview Of Food,Nutrition & Health in Islamic Republic of Pakistan

1. COUNTRY PRESENTATION An Overview Of Food,Nutrition & Health in Islamic Republic of Pakistan Intercountry Technical Consultation on National Food based Dietary Guidelines.6th to 9th Dec.2004 WHO-EMRO,Cairo,Egypt Presented By: Prof.Dr.Perveen Liaqat

2. COUNTRY INTRODUCTION

3. Demographic Indicators Population 130.580 million (PCP 1998) 140 million (Economic Survey03-04) Population Growth Rate 2.2% (Economic Survey 2003-2004) 1.9% (World Development Report 2003) Economy Agriculture Based Main Food Crops Wheat,Rice,Sugarcane Literacy Rate 43.9% (Population census 1998) 54.0% (Economic Survey,estimated 03-04) (66.25 %M & 41.75% F) Life Expectancy M: 64 years; F:66 years(Pak Dev.House hold survey 1999) Mortality Rate(Infant) 91 (PCP 1998) 81 (Economic survey 2003-2004) Mortality Rate(Under Five) 120 (PCP 1998) 105 (Economic survey 2003-2004)

4. 1. Food Security Situation in Pakistan Food security according to World Food Summit is defined as “When all people, at all times, have physical and economic access to sufficient, safe and nutritious food and to meet their dietary needs and food preferences for an active and healthy life”. • Adequacy of Food • Ample Access to Food • Reliability of Both Supply and Access

5. 1.1 Adequacy of Food • Food Production a) Major Food Crops Production of major Food Crops (000 Tonnes) Source: (Economic Survey of Pakistan 2003)

6. Wheat Production (000 Tonnes) Rice Production (000 Tonnes) Rice Production (000 Tonnes) Sugarcane Production (000 Tonnes) Source: Economic Survey 2003

7. b) Other Important Foods Commodities Live Stock: Accounts for 49.1% of agricultural value added and about 11.4% of the GDP 30-35 million rural population is engaged in livestock raising Live Stock include cattle, buffalos, sheep, goats, camels, horses assess and mulesPoultry: Good substitute of beef and muttonAccording to Live Stock Wing of Ministry of food, agriculture and livestock, almost every family in rural area and every fifth family in urban area in associated with poultry productionFisheries: Fisheries contribute substantially to the national income through export earningsDuring July-March 2003-04, 101256 m.tones values at Rs.7.9 billion fish and fishery products were estimated to be exported to Japan, USA, UK, Germany, Middle East, Sri Lanka, China etc.During the same period, the total fish production is estimated at 630,000 m.tonesThe total number of persons engaged in fisheries during 2003-04 is estimated at 395,000 Source: (Economic Survey of Pakistan 2003)

8. c) Exports and Imports of Food Products Exports: Cumulative Exports by Food Commodities

9. c) Exports and Imports of Food Products Imports: Cumulative Imports by Food Commodities

10. 2. Food Consumption Food availability per Capita Per capita availability of calories and Protein Source: Planning & Development Division (PES, 2001-2002)

11. 1.2 Ample access to Food • Poverty Trends in Food Poverty Incidence Source: PIDE 1998-99 PSES primary data &Food security analysis 2003

12. 2. Unemployment Unemployment 7.8% Source: (Economic Survey of Pakistan 2003) 3. Lack of Nutrition awareness and Education

13. 1.3 Reliability of both Supply and Access 1. Inequity in land holdings • 40% total farm area 7% landowners • 60% total farm area 93% farmers • Landowners have more access to water for irrigation, fertilizers and other resources 2. Inequity in food supply in different provinces

14. 2. Nutrition Indicators of Malnutrition i.Low Birth weight ii. Childhood Growth a) Time trend in prevalence of stunting,wasting & underweight b) Prevalence of Stunting & Wasting among Gender

15. Prevalence of Stunting and Wasting among Rural/Urban children under five.

16. iii. BMI as Nutrition Indicator during Pregnancy & Lactation • Underweight Non-pregnant mothers 12.5% (Malnourished with BMI<18.5) • Underweight Lactating Mothers 16.1% (Malnourished with BMI<18.5) • Mothers with normal limits of Nutrition 54% • Lactating Mothers More underweight as compare to less Obese non-pregnant women Source: NNS 2001-2002

17. 2.1 Prevalence of Micronutrient Deficiencies as Malnutrition Indicators a) Prevalence of Iron Deficiency Anemia Iron deficiency Anemia among Children under five & their Mothers

18. b) Prevalence of Vitamin A Deficiency • Clinical Deficiency Bitot spots,night blindness,xerophthalmia • Sub-clinical Deficiencies Serum Retinol level <0.74 (mol/l) among pre-school children & their mothers • Bio-chemical levels of vitamin A among Mothers Source: NNS 2001-2002

19. c) Prevalence of Iodine Deficiency • Clinical Signs Visible goitre among mothers 12.2% Palpable goitre among mothers 8.9% • Prevalence of goitre among Mothers by place of Residence • Prevalence of goitre among school-aged children 6-12 years

20. d) Prevalence of Zinc Deficiency (NNS 2001-2002) Pre school Children 37.1% (Serum Concentrations< 60 /dl Zinc level) Pregnant Women 41.4% (mother of children under five)

21. e) Vitamin B Deficiencies • Sub Clinical Signs(urinary excretion levels) • a) Thiamine • Adults 0.87% • Children 1.85% • b) Riboflavin • adults 0.25% • children 0.71% Source: NNS 1985

22. 2.2 Childhood Morbidity as an indicator a) Prevalence of vitamin D Deficiency among children upto 59 months • Clinical Signs of Rickets i. Enlarged Wrist 0.8% ii. Bowed legs 0.5% iii. Fontenelle (<2 years) 41.8% iv. Frontal Bossing(3-5 years) 2.9% b) Prevalence of Diarrhoea among Children National level 25% Urban 20.8% Rural 27.5%

23. 2.3 Overweight and Obesity as indicators of Malnutrition Percent urban Male & Female Obese Overweight Desirable Underweight Severe thin LOW Middle High Female LOW Middle High Male Source: (NHS 1998)

24. 2.4 Chronic Diseases Related with Overweight and Obesity i. Serum Cholestrol level ii. Blood pressures and Hypertension iii. Non-insulin dependent diabetes

25. 2.4.1 Prevalence of elevated cholestrol levels People with ECL requiring Nutritional/medical advice 7.3 million 12.6% population Over 15 years of ages Urban women over 65 years of age 1/every 3 much higher than their male counter parts ECL: Elevated Cholestrol Levels (random blood cholestrol of at least 200 mg/ml) Source: NNS 1990-94

26. 2.4.2 Prevalence of high blood pressure & Hypertension • Blood Pressure(systolic>140 mmHg & Diastolic 90mmHg) • Urban 21.5% • Rural 16.2% • Hypertension • Men 5.5 million • Women 5.3 million • Severe Hypertension 4% urban women of high economic status • Systolic pressure > 180 mmHg • Diastolic pressure> 105 mmHg • Obese urban Female Over 45 years of age 65% hypertensive • Obese rural Female Over 45 years of age 48% hypertensive • Overweight Male(age 45+) 58% hypertensive both rural & urban Percent rural Percent urban * * Female Male Female Male Source: (NHS 1994)

27. 2.4.3 Prevalence of Diabetes among 45-64 years age Non recorded diabetes 2.7million Diagnosed diabetes 0.8 million Urban Male(over 65 yrs age) 15% Urban Female(45 to 64 yrs) 18% Rural Male 5% Rural Female(45 to 64 yrs) 7% Prevalence of diabetes among urban female one in every 4th of 45 years & above Source: (NHS 1994)

28. 2.5 Other Health Diseases Common • Chronic Bronchitis caused by Tuberculosis & Chronic Obstructive Pulmonary Disease (COPD) • Rural Women(age 65 and above) 14% • Rural Men 6% • Urban(both sexes) 9% • Renal Impairment • Chronic Kidney problems * • (Among 40-49 yrs of age group ) 7% • (Among 50-59 yrs of age group) 17% • 60+ in both rural and urban areas 13% * It includes renal insufficiency and creatinine. Renal insufficiency is a clinical condition in which blood urea nitrogen is over 40 mg/dl and creatinine is over 1.2 mg/dl. It is used to monitor kidney function and early screening. Source:NHS 1990-4

29. 3. DAILY FOOD INTAKE PATTERN • 3.1 Average daily intake of food by Mothers (NNS 2001-02) • 3.2 Average Intake of Food by Children-by Food Groups • 3.3 Type of Bread Consumed by Regions • 3.4 Consumption Frequency of different food items for weak • 3.5 Pakistan Food Basket based on 2100 Calories

30. 3.1 Average Intake of Food by Mothers-by Food Groups grams/person/day Source:NNS 2001-02

31. 3.2 Average Intake of Food by Children-by Food Groups Grams/child/day 3.3 Types of Wheat Bread Consumed by Regions Source: NNS 2001-02

32. 3.4 Consumption Frequency of Different Food Items Per Week Percent Source: NNS 2001-02

33. 3.5 Pakistan Food Basket Based on (2100 calories) Average Caloric Requirement/ Capita/ day (proposed) (at physiological Level)

34. 4. Food and Nutritional National policies 9th five year programme(2003-08) Capacity development at all levels to address nutritional problems Control of nutritional disorders Universal accessibility to safe and balanced food Awareness through education for healthy lifestyle and adopting improved nutritional practices Initiation of community based growth monitoring policy for young child and maternal nutrition. Promotion and protection of breastfeeding. Development of strategic frame work. Consensus building among stakeholders for graphical & practical national nutrition strategic plan National fond fortification Research a) Food Dietary Guidelines b) Efficiency of single close vitamin A and Serum retinol level in lactating mothers Micro nutrient supplementation 4.1 Existing

35. 4.2 Ongoing Nutrition programmes and Projects • Tawana Pakistan: School Nutrition Package for girls • National Programme for Family Planning and Primary Health Care/ The Lady Health Workers Programme • Bait-ul-Mal’s Food Support Programme • Pakistan Standards and Quality Control Authority

36. 4.3 International Organizations (working on Food,Nutrition and Health) • World Health Organization • Micronutrient Initiative (MI) US aid Supported Programme • FAO • British Council • DFID • Save the Children Fund • Unicef • Unesco

37. 4.4 EDUCATIONAL INSTITUTES IMPARTING NUTRITION EDUCATION AND RESEARCH • Department of Preventive Peadiatrics, KEMC, Punjab • Faisalabad Agricultural University, Punjab • Department of Human Nutrition, NWFP Agriculture University • Pakistan Institute of Community Ophthalmology (PICO), NWFP • Nuclear Institute of Food and Agriculture (NIFA), NWFP • Agha Kahn University, Sindh • Department of Pediatrics, Unit 1, Civil Hospital, Karachi • Department of Home and Health Sciences, Allama Iqbal Open University (National Level) • Departments of Food & Nutrition at Home Economics Colleges at Provincial level

38. 4.5 NON-GOVERNMENT ORGANIZATIONS(working on nutrition & health) • Society for the Protection of the Rights of Child (SPARC), Islamabad • Society for the Advancement of Community, Health, Education and Training (SACHET), Islamabad • Punjab Lok Sujag • Jahandad Society for Community Development (JSCD), Punjab • Oxfam NGO, Balochistan

39. 4.6 GOVERNMENT stake holders (working on Different Nutrition Programmes) • Ministry of Health: Nutrition Wing National Nutrition Programme USI/ IDD Prevention Programme Vitamin A supplementation Programme World Food programme CBNP/ Baby Friendly Hospital Initiative (BFHI) Programme Nutrition rehabilitation unit (NRU) programme in NWFP Nutrition Support Programme in Sindh National food fortification programme • Nutrition Section, Planning and Development Division, Government of Pakistan Universal Salt Iodization Programme IDD Workshop Research, Publications, Literature Micronutrient fortification in collaboration with MI • National Institute of Health   Applied Research Laboratory Services IDD control Programmes in AJK, NA and Parts of NWFP

40. 4.7 Summary of Nutritional Problems and Underlying Causes:

41. 5. Pakistan’s Vision for Food Based Dietary Guide lines • Healthy Balanced Diet for average Pakistani

42. 6. Pakistan’s Vision for Food Based Dietary Guide lines b) Healthy Balanced Diet for average Pakistani Child