Putting Pakistan on the Nutrition Map 2013

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  • 1. The Importance of Research: Putting Pakistan on the Nutritional Map Nilofer Fatimi Safdar, PhD Director Nutritional Science Program School of Public Health, DUHS, Pakistan President, PNDS
  • 2. What is Research?  Work that adds to scientist's knowledge of how things happen  Pursuing knowledge through scientific discovery  Using a scientific method to an investigation / inquiry  It’s the cornerstone to any health care discipline
  • 3. Advantages of Doing Research  Enhancement in knowledge, skills, & competency  Develops critical thinking  Improves ability to conduct subsequent well-designed studies  Support professional growth of members  Reflects in the standards of professional practice  Becomes an advocacy of your profession
  • 4. Areas of Nutrition Research Conducted in Pakistan  Nutrition Surveys  Under nutrition among reproductive women & children  Breast & complementary feeding in children  Macronutrient deficiencies (PCM)  Micronutrient deficiencies (Iodine,Vitamin A & iron)  Risk factors & determinants of malnutrition  Factors underlying the lack of improvement in nutrition indicators
  • 5. Nutrition Surveys in Pakistan  Nutritional Survey ofWest Pakistan, 1965  Micronutrient Survey Pakistan, 1976-77  National Nutrition Survey Pakistan, 1985-87  National Health Survey of Pakistan (NHSP),1990-94  National Nutrition Survey Pakistan, 2001-2002  National Nutrition Survey Pakistan, 2011
  • 6. Purpose of Nutrition Surveys in Pakistan  Estimate the nutrition problem / benchmark for the future  Identify population groups at risk  Assess food security & their impact on nutritional status  Identify the need for nutrition interventions  To help establish or expand existing surveillance
  • 7. Survey Team Members  Economist  Social Scientists  Research & Survey experts  Medical doctors/ Physicians  Pediatrician
  • 8. Results of National Surveys
  • 9. Results of National Surveys  Malnutrition recognized as a major public health problem  High numbers to substantiate the extent of malnutrition  Meetings & workshops are organized to plan strategies for reducing malnutrition  Policies and intervention programs are promoted  Reports are compiled  Nutrition gets into the agenda of academia /researchers  Donors gets activated
  • 10. What next?  Yet malnutrition prevails  Successive governments have not recognized the importance & impact of nutrition in the health & development of the people  None of the surveys have resulted in a national intervention program aimed at addressing the root causes of malnutrition  NGOs mostly take over public health nutrition concerns
  • 11. NGOs in Pakistan  National  HANDS  HOPE  International  Asia Foundation  UNICEF  Micronutrient Initiatives (MI)  Care  WHO
  • 12. Key Areas of Nutritional Intervention in Pakistan  Child & Maternal under nutrition  Micronutrient deficiencies  Breast & complementary feedings  Infant and young Child feeding programs
  • 13. Nutrition Programs in Pakistan  Fortification of edible oil with vitamin A & D (1965)  Supplementary feeding of vulnerable groups (1976)  Rural Child Survival Project (1987)  Nutrition Support Program Sind (1989-90)  Lactation Management Program of baby friendly hospitals (1992)  Iodine Deficiency Disorder National Program (1994)
  • 14. Nutrition Programs in Pakistan  School Nutrition Program (1998)  MassVitamin A supplementation (1999)  Bait-ul-mal Food Support program (2000/2002)  National Wheat Fortification with iron & folate (2005)  Universal salt iodization (2006)  Lady HealthWorkers to provide nutrition education as part of family planning program (2010)
  • 15. Outcome of Nutrition Surveys & Programs in Pakistan  Minimal public awareness at a national level on the importance of nutrition in the social and economic development of the society  Nutrition remains the key element missing from the widely discredited Social Action Program  Few initiatives that addresses food & nutrition research with qualified people in the public health nutrition issues
  • 16. What could be the Reasons?  Failure of the Govt, those who undertake surveys, & those who implement? Collective Failure  Focus is mainly on assessing indicators  Less or nil on identifying causal factors  Lack of qualitative aspect of malnutrition with dietary factors  Absence of an expert nutritionist in the survey & intervention team
  • 17. Tawana Pakistan Project (TPP): 2002-05  Intersectoral project  29 districts  4,000 primary schools  Focused on girls (5-12 yrs) nutritional status  Paid attention to fundamental drivers of malnutrition  Participatory approach  Field experts  Culturally appropriate, low cost & local food,  Nutrition education supplemented the program  Delivery mechanism to maximize program efficiency Badruddin SH, et al. (2008). Asia Pac J Clin Nutr 17 Suppl 1, 357-360
  • 18. Tawana Pakistan Project- Results  Increased ability of women to plan nutritionally balanced meals from 4.7 % to 34.4%  Overall malnutrition rate decreased  wasting by 45%  underweight by 22%  stunting by 6%  Increased school enrollments  Improved dietary knowledge in the communities
  • 19. Tawana Pakistan Project- Why was it stopped?  Intersecterol projects  Lack of commitment from the Govt  Prevented siphoning away of funds  Self interest of higher officials  Globalization- commodity push
  • 20. Pakistani Journals Publishing Nutrition Research  Journal of Pakistan Medical Association  Journal of College of Physicians and Surgeons Pakistan  Pakistan Journal of Public Health  Pakistan Journal of Medical Sciences  Journal of Ayub Medical College  Pakistan Journal of Biological Sciences  Nurture (Home Economics Journal)
  • 21. Published Nutrition Research in Pakistan (2001-2010) Year National Journals International journals nutrition expert among the authors others (Pediatricians, Physicians, economist, health experts) 2001 4 3 3 4 2002 3 7 3 7 2003 5 6 1 10 2004 5 12 2 15 2005 3 8 none 11 2006 1 4 1 4 2007 5 1 none 6 2008 8 9 4 13 2009 5 9 1 13 2010 9 4 none 13
  • 22. Nutrition Research in Pakistan (1965-2003)  Major area-Therapeutic Nutrition  Search Engine-medline database, pakmedinet & nutrition gate  Number- 99 research  Major topics- Diarrhea, diabetes and cancer  Authors- Pediatrician, Physicians, Food Scientist  Institutes-AKU, JPMC  Journal - JPMA. Tahir,S (2003) M.ScThesis; College of Home Economics, Karachi
  • 23. Who are mostly the stake holders in nutrition related research?  Experts in various sciences other than nutrition  Many of these professionals lack education, training & expertise in food & nutrition  Net impact negligible in terms of nutrition awareness or improvement in nutritional situation in the population  You are supposedly the spokesperson in promoting the relationship between good health and diet
  • 24. COBRA –Trial (2004-2007)  Dietary information using FFQ  Physical activity assessment using IPQ  Intervention in the form of Home Health Nutrition Education, counseling & reinforcement  Expertise involved for Diet & Nutrition Component of COBRA study were qualified people in their respective areas  Papers published to evaluate the efficacy of this program Jafar TH, et al. (2010) BMJ ; 340, 2641.
  • 25. Dietitians/ Nutritionist Million Population 0 50 100 150 200 250 300 350 400 Pakistan Hong Kong Thailand Philippines Malaysia Indonesia Singapore Taiwan Korea Japan Asia Slide Courtesy: AFDA 2006
  • 26. Where do we mostly work? Health Care Facility Community Health Agency Institution Foodservice Establishment Educational Institutes Business Company Consultant, Private Practice Others Slide Courtesy: AFDA 2006
  • 27. Nutrition Research Gaps Among Us  Lack of leadership role & responsibility in food and nutrition research  Hesitant to play a participatory role in nutrition research  Lack of research ability to conduct well-designed studies  Lack of research undertaken to address the impact of nutrition related behaviors, attitudes or cultural practices on nutritional status  Unable to disseminate sound scientific information on food & nutrition to other health professionals
  • 28. Schiller et al. J Am Diet Assoc. 1988;88 (9):1070-1075 Research Activities & Interests of Dietetic Educators  Factors that influence research involvement /publications among dietetics/nutrition professionals  Postal questionnaire survey in USA  Factors inhibiting research  Education  Lack ofTraining in Research Skills  Lack of Funds  Lack of Administrative Support  Poorly Defined Job Description  Factors promoting  Analytical thinking  Good computer skills  Degree???
  • 29. Whelan et al. J Acad Nutr Diet. 2012;112:1021-1028 Factors that Influence Research Involvement among Nutrition Professionals  Qualitative Study, semi structured interviews with 13 nutrition faculty members in UK universities  Themes emerged  Institution/ department (size and structure, research Philosophy)  Activities (faculty roles, time, funds, training, teaching)  The Influence of self / individuals  Overcoming barriers to research involvement is essential for the development of the individual, the discipline & the community
  • 30. The Road Forward ……  Visibility  Raise your visibility and impact among those who matters the most  Identify weaknesses & Competencies  Commitment to education, learning, training as a researcher  Vision  Multi task & prioritize to handle the task  Be Assertive  Learn to handle criticism, but be positive
  • 31. Future Directions  A national vision needed to guide priorities & to sustain momentum  Invest in training of qualified nutrition experts in research & development  Boost the morale of nutrition experts & develop research culture  Conduct validity studies for diet assessment techniques  Conduct studies of nutrients & disease outcome  Qualitative research
  • 32. What PNDS can do to Help you…….  Spark a stronger research effort  Organize workshops, seminars, courses & training for conducting research studies  Promote research culture through professional advocacy  Help you translate your work into scientific nutritional concerns & public health issues in Pakistan  Expand your role as a researcher in the health-care environment through the society’s platform  Generate funds to assist researcher
  • 33. Symposium Outcomes  Platform to present your research work  Opportunity to enhance key concepts in good quality nutrition research  Help seasoned researcher and nutrition research novice  Offers opportunities for a fresh perspective and innovation in food, nutrition & dietetics
  • 34. ‘Research is at the heart of everything we do. We need a rigorous knowledge base in order to make sound clinical decisions and give credible nutrition advice’. Dr Susan C. Finn, AND, Foundation Chair for Research Endowment Fund, 2004 ‘Nutrition has historically received just a tiny sliver of the pie when it comes to aid money. But that is slowly changing’. Dr Zulfiqar A. Bhutta, Director of Research for Global Child Health, Toronto Global Health Report, published on 23rd June’, 2013
  • 35. Possess Passion for Your Profession Never lose your Zest and Curiosity !