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Stunted, lean and indolent children; this is, perhaps, the picture of our future. It’s a bitter yet an undeniable truth; because the diet we are feeding our children with though satisfies their hunger, their bodies remain deprived of adequate nutrition – essential vitamins and minerals (collectively micronutrients). This is a state of malnutrition which is commonly referred to as ‘Hidden Hunger’. An inadequacy of all essential micronutrients in diet leads to stunted physical and mental growth of the children and also adversely impacts women’s health, especially that of the pregnant and lactating women, because their nutritional needs are not adequately met. Hence, a major chunk of the foundations of the edifice of our future (children) and the builders of that (mothers) are grappling with health complications.
Hidden hunger manifests a state of deficiency in humans of essential micronutrients, i.e. vitamins and minerals. Notwithstanding that our body needs only little amounts of micronutrients, they are no less than a magic wand because our body uses them to produce different enzymes, hormones and other elements that are highly important for physical and mental growth. Starting from its very conception, the first thousand days of a baby’s life are of critical importance as a lack or even deficiency of micronutrients during this period may have far-reaching consequences. Research has increasingly established that by providing balanced diet in this period, we can save nearly a million newborns a year, and also safeguard them against diseases.
Among micronutrients, taking proper amounts of Vitamin A, Zinc and Vitamin D is very important for good health. Nutritionists opine that iodine deficiency damages the brain of a newborn – thus impairing its mental growth – and causes enlargement of the thyroid. Likewise, effects of early-life iron deficiency include irreversible deficits in learning and memory, maternal mortality, premature births, lack of vigour and vitality, which often leads to indolence and enervation. Moreover, the deficiency of Vitamin A deteriorates eyesight– and causes many other diseases like blindness, diarrhoea and measles among the school-going children. This can also lead to night-blindness in, or even death of, a pregnant woman.
Moreover, deficiency of zinc affects the functioning of body’s immune system, slows height-for-age growth and results in recurrence of infections. Similarly, deficiency of Vitamin D has been found to cause various illnesses to adults because this is the very nutrient every single cell of our body needs in order to function properly. The body will properly absorb the calcium taken from food, only when vitamin D is present in the required quantities. It is important to note here that calcium is very important for strengthening of bones and teeth and for better functioning of the nervous system. The level of vitamin D in a newborn is similar to that of its mother; so, if the mother had been deficient on it during pregnancy, the effects on the baby will be clearly visible. An acute deficiency of vitamin D can also cause rickets in kids. Owing to lack of proper formation of bones, the baby may be born with low height and with bowed legs. Sometimes, the low level of calcium in the blood makes a child have fits and convulsions. In addition, a severe shortage may also cause muscle pain and fatigue.
With its numerous adverse impacts, hidden hunger keeps inflicting damage to the human body; right from childhood to adolescence and to the old age. It causes birth of underweight babies, increases mortality rate among infants, hampers mental growth of a baby and leads to low height-for-age among kids. The kids, who are the victims of hidden hunger, have reduced cognitive abilities, remain chronically ill, get abnormally exhausted, have poor learning skills and are vulnerable to death. The adolescents may have low height-for-age, limited mental abilities, fatigue and otiosity, no vigour to partake in sports activities and increased exposure to ailments and infections. Victims of poor nutrition often belong to the low stratum of the society, and the big reason for this is that persistent illnesses keep them away from actively taking part in productive economic activities. Similarly, pregnant women either develop complications or become more prone to death. Osteoporosis and physical and mental debility in the old age are also the manifestations of the micronutrient deficiency. Furthermore, owing to the absence of proper quantities of micronutrients, an already weak immune system becomes further weaker, which, in turn, effects an increases in mortality rate. In fine, this menace we call ‘hidden hunger’ not only has deleterious impacts on people’s health but also has serious ramifications for socioeconomic development of a country – as per Food and Agriculture Organization of the United Nations (FAO), it causes economic loss of between 1.4 and 2.1 trillion US dollars annually, and nearly one-third of the world population is reeling under the claws of hidden hunger.
Read More: The dilemma of malnutrition
We often see that children are born underweight. This, again, happens only due to micronutrient deficiency; when mothers would not get the diet that adequately fulfils their nutritional needs, how would the foetus grow properly? This is also a major cause behind the problem of anaemia that further gets complicated during the period of pregnancy. As per a World Bank report, nearly 51.3 percent of pregnant women in Pakistan suffer from anaemia – 22nd largest figure in the world. Owing to this deficiency, the health of the mother, ergo of the child, gets affected, thus, the birth of an underweight, weak baby that may also contract many other diseases. Moreover, the possibilities of premature births increase manifold, and it is the biggest reason behind high ratio of infant mortality in Pakistan. The graveness of the situation in our country can be gauged from the UNICEF data according to which nearly 32 percent of newborns in Pakistan are underweight (they weigh below 2.5 kilogrammes) – second biggest ratio in the world. Moreover, the neonatal (relating to the infant during the first month after birth) mortality rate is 46 per 1000.
The problem of anaemia and almost zero intake of proper nutritious diet in postnatal period incapacitate a mother from feeding her child only with breast milk during the first six months of its age. Unicef’s report “The State of the World’s Children 2017” further reveals that only 18 percent of Pakistani mothers breastfeed their babies during the first hour after birth – the fifth lowest ratio in the world. Likewise, the ratio of breastfeeding the babies during first six months of life is 37.7 percent while that for up to two years is 56.1 percent. Breast milk is the best and a perfectly nutritious food for healthy growth of the baby because it contains, in perfect combination, all the nutrients that are essentially required for proper physical and mental growth of the baby.
Medical science has established that breast milk safeguards the baby against various infections, illnesses and allergies, and also boosts its immune system. But, if a baby remains deprived of this great gift of the nature, its immune system will not be robust enough to let it grow mentally and physically – let alone fighting the diseases. Moreover, everything a baby may be given, except mother’s milk, is devoid of micronutrients and this is where the situation becomes more alarming. This is why, in terms of infant mortality rate, Pakistan is at 11th place in the world with a ratio of 46 per 1000 babies. In Pakistan, every year, nearly 424,000 babies die before reaching the age of five – the third biggest ratio in the world. Pakistan has the world’s 20th largest under-5 mortality rate with a ratio of 78 per 1000. FAO figures also suggest that, in Pakistan, as many as 177,000 children die before attaining the age of 5 years and the principal reason behind is improper diet of the mothers. In addition, around 90 million cases of diarrhoea and respiratory infections are reported among children and the major cause, again, is the low ratio of breastfeeding and deficiency of zinc.
It is also important to mention here that the children suffering from micronutrient deficiency have stunted growth. So, they lag behind their healthy friends in all fields of life. The figures reported in the latest Pakistan Demographic and Health Survey 2017-18 warrant special attention of those in the corridors of power because the picture presented therein of the health of our children is dreadful, to say the least. As per the Survey, 38 percent children in Pakistan – or nearly every third child – are stunted, 7 percent of under-5 children are wasted (had low height-for-age) and 23 percent – approximately every fourth child – are underweight.
Among a multitude of factors responsible for this perplexing state of affairs regarding the nutritional health of our children, the one that is most conspicuous is an imbalance among nutrients in diet consumed by children and mothers. Figures presented in the National Nutrition Survey 2011 sufficiently corroborate this assertion. As per the Survey, following deficiencies were found among women in Pakistan:
Likewise, the data related to micronutrient deficiencies among children is no less alarming. The Survey reports that 61.9 percent of Pakistani children less than 5 years of age are anaemic. The highest ratio of anaemic children is found in Sindh (72.5%), followed by Punjab (60.3%), Balochistan (56.8%), Khyber Pakhtunkhwa (47.3%) and Azad Jammu and Kashmir (46%) whereas this ratio in Gilgit Baltistan (GB) is 41 percent.
Similarly, the Survey suggests that 43.5 percent of Pakistani children below 5 years of age have iron deficiency. On this list, Punjab is at the top with a ratio of 48.6 percent, followed by AJK (43.5%), Sindh (40.6%), GB (36.2%), Balochistan (32.5%) and KP (26.4%).
Our daily diet, which basically consists of maize, wheat or rice, although provide us with energy, yet the quantities of essential vitamins and minerals they give are far less than what the human body requires. And, this is the reason behind hidden hunger. Those having hidden hunger fail to understand the importance of balanced and nutritious diet because most of them do not have adequate financial resources to have access to such diet, especially animal-based foods, e.g. meat, eggs, fish and dairy. In Pakistan, nearly 68 percent households cannot afford to have a proper nutritious diet – perplexingly 5 percent cannot meet even the minimum requirement. As per a report “Fill the Nutrient Gap Pakistan” of the World Food Programme which was released in November 2017, nearly 80 percent households cannot afford to have nutritious diet. This ratio is 67 percent in Sindh and KP, 60 percent in Punjab and 32 percent in Islamabad. The report further revealed that only 3 percent of infants and young children in Pakistan consume an adequately diverse diet.
In societies where hidden hunger spreads its tentacles, most people fail to be productive members. This causes malnutrition, poor health conditions and low productivity, which, in turn, increases poverty and slows down economic growth. Pakistan is also facing a similar situation as according to the “Scaling Up Nutrition (SUN)” a report prepared by the Ministry of Planning Development and Reform, in collaboration with the United Nations World Food Programme (WFP), a cumulative effect of lost manpower hours, healthcare expenses and lower productivity due to malnutrition in monetary terms in Pakistan is $7.6 billion – or around three percent of its Gross Domestic Product (GDP) – every year. With all these facts and figures, Pakistan is at 63rd place on the Global Hidden Hunger Index out of 149 countries.
Poor nutrition or malnutrition has multifarious impacts and it can be tackled by adopting only a multipronged policy. Steps like providing proper, nutritious diet to pregnant women and lactating mothers, feeding the baby with only breast milk for at least first two years of its life, providing healthy, nutritious diet while the child is growing up, and provision of basic facilities like those of health, clean drinking water, proper hygiene and better sanitation are very important in this regard. Besides, provision of opportunities to partake in sports and setting of targets of resolving the nutrition crisis can be instrumental to curbing this menace.
And, for that purpose, the World Health Organization (WHO) has set the six global nutrition targets that by 2025 aim to:
1. achieve a 40 percent reduction in the number of children under-5 who are stunted;
2. achieve a 50 percent reduction of anaemia in women of reproductive age;
3. achieve a 30 percent reduction in low birth weight;
4. ensure that there is no increase in childhood overweight;
5. increase the rate of exclusive breastfeeding in the first 6 months up to at least 50 percent;
6. reduce and maintain childhood wasting to less than 5 percent.
Although people usually find poverty the biggest reason behind poor state of nutrition, yet another one that often goes unnoticed is lack of awareness in common man on diet and nutrition. Most people don’t know as to what is a proper and balanced diet, which food provides us with what nutrients, what to eat to cope with malnutrition and what foods should we avoid. Besides this prevalent lack of awareness, some practices that, unfortunately, have gained currency in our society are further aggravating the problem, e.g. not breastfeeding the baby, use of formula milk, giving no additional food, or the one rich in required nutrients, to a child of above six months of age, increasing use of potato chips, cold drink, energy drinks, bakery items, fast foods (burgers, pizzas and shawarma) and many others.
So, there is a pressing need to put in concerted efforts at individual as well as collective level to counter this situation. State institutions, too, should come forward and fulfil their responsibilities in this regard. It is the only way to build our next generation so healthy in mental faculties and physical abilities that they have everything that is required to steer the country in the right direction.