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  • 1. 1 An Overview Of Food,Nutrition & Health in Islamic Republic of Pakistan Presented By: Prof.Dr.Perveen Liaqat COUNTRY PRESENTATION Intercountry Technical Consultation on National Food based Dietary Guidelines.6th to 9th Dec.2004 WHO-EMRO,Cairo,Egypt
  • 2. 2 COUNTRY INTRODUCTION
  • 3. 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. 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”. 1. Adequacy of Food 2. Ample Access to Food 3. Reliability of Both Supply and Access
  • 5. 5 1.1 Adequacy of Food 1. Food Production Production of major Food Crops (000 Tonnes) Source: (Economic Survey of Pakistan 2003) a) Major Food Crops Years Sugar Cane Rice Maize Wheat 1999-00 46333 5156 1652 21079 2000-01 43606 (-5.9) 4803 (-6.8) 1643 (-0.5) 19024 (-9.7) 2001-02 48042 (10.2) 3882 (-19.2) 1664 (1.3) 18227 (-4.2) 2002-03 52056 (8.3) 4478 (15.3) 1771 (4.4) 19767 (5.2)
  • 6. 6 10000 12000 14000 16000 18000 20000 22000 90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 2001-02 3-Feb 03-04(P) Wheat Production (000 Tonnes) Rice Production (000 Tonnes) 2000 2500 3000 3500 4000 4500 5000 5500 90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-012001-02 3-Feb03-04(P) Sugarcane Production (000 Tonnes) 30000 35000 40000 45000 50000 55000 60000 90 -91 91 -9 2 92 -9 3 93 -9 4 94 -9 5 95 -96 9 6-97 9 7-98 9 8-99 99 -00 00 -0120 0 1-02 3-F e b03 -04 (P ) Source: Economic Survey 2003 Rice Production (000 Tonnes)
  • 7. 7 Source: (Economic Survey of Pakistan 2003) 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 mules Poultry: Good substitute of beef and mutton According 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 production Fisheries: Fisheries contribute substantially to the national income through export earnings During 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.tones The total number of persons engaged in fisheries during 2003-04 is estimated at 395,000
  • 8. 8 c) Exports and Imports of Food Products Exports: Cumulative Exports by Food Commodities Commodities July-Aug, 2004 in millions July-Aug, 2003 in millions % Change July-Aug, 2004 July-Aug, 2003 Rice 5,575.61 5,743.94 -2.93% Fruits, Vegetables and preparation thereof 1,538.97 1,297.41 +18.62% Fish and Fish preparation 981.33 1,330.59 -26.25%
  • 9. 9 c) Exports and Imports of Food Products Imports: Cumulative Imports by Food Commodities Commodities July-Aug, 2004 in millions July-Aug, 2003 in millions % Change July-Aug, 2004 July-Aug, 2003 Palm Oil 7,401.00 5,522.43 +34.02% Tea 2,240.11 1,479.39 +51.42% Pulses 1,140.71 477.36 +138.96% Soybean oil 238.39 274.29 -13.09% Milk and Milk products for infants 194.61 113.13 +72.02%
  • 10. 10 Items Units 1997-98 1998-99 1999-2000 2001-2002 Cereals Kg 159.7 171.0 163.5 149.3 Pulses Kg 5.9 6.8 7.2 6.1 Sugar Kg 32.8 31.2 26.4 26.1 Milk ltr 147.3 148.0 148.8 150.8 Eggs Doz 2.2 5.1 25.1 5.2 Edible Oil ltr 11.6 12.3 11.1 11.3 Meat Kg 17.9 18.2 18.7 18.9 Calories (per day) 2,655 2,728 2,625 2,306 Protein (per day) gms 68.37 71.85 70.00 67.00 Source: Planning & Development Division (PES, 2001-2002) 2. Food Consumption Food availability per Capita Per capita availability of calories and Protein
  • 11. 11 1.2 Ample access to Food 1. Poverty Year Pakistan Rural Urban 1986-87 26.9 29.4 24.5 1987-88 17.3 29.9 22.7 1990-91 23.3 26.2 18.2 1992-93 20.3 22.5 16.8 1993-94 23.6 26.3 (WFP) 19.4(WFP) 1998-99 32.6 34.8 (WFP) 25.9 2002-2003 62.0 Trends in Food Poverty Incidence Source: PIDE 1998-99 PSES primary data &Food security analysis 2003
  • 12. 12 2. Unemployment Unemployment 7.8% Source: (Economic Survey of Pakistan 2003) 3. Lack of Nutrition awareness and Education
  • 13. 13 1.3 Reliability of both Supply and Access 40% total farm area 7% landowners 60% total farm area 93% farmers • Landowners have more access to water for irrigation, fertilizers and other resources 1. Inequity in land holdings 2. Inequity in food supply in different provinces
  • 14. 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 Source NSWP MNS NNS NHS NNS Year 1965 1977 1985-7 1990-4 2001-2 Underweight - 53.3 47.9 40.1 37.4 Stunted 49 43.3 41.8 36.3 40 Wasted 11 8.6 10.8 11.8 14.9 Source NHS NNS Year 1990-4 2001-2 Males Females Males Females Stunted 36.0 36.3 40.5% 39.5% Wasted 11.9 11.7 15.4% 14.4% Underweight 39.8 40.5 37.6% 37.2%
  • 15. 15 c) Prevalence of Stunting and Wasting among Rural/Urban children under five. Source NHS NNS Year 1990-4 2001-2 Urban Rural Urban Rural Stunted 32.1 39.0 34.7% 43.1% Wasted 11.2 11.5 15.5% 14.6% Underweight 34.5 41.6 34.7% 39.0%
  • 16. 16  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 iii. BMI as Nutrition Indicator during Pregnancy & Lactation
  • 17. 17 2.1 Prevalence of Micronutrient Deficiencies as Malnutrition Indicators a) Prevalence of Iron Deficiency Anemia Moderate Severe Children 33.0% 2.6% Mothers 23.7% 1.8% Iron deficiency Anemia among Children under five & their Mothers
  • 18. 18 b) Prevalence of Vitamin A Deficiency  Clinical Deficiency Bitot spots,night blindness,xerophthalmia Prevalence of Bitot spots among children under five 1.2%(NNS 2001-2002) Prevalence of Night blindness among mothers (during last pregnancy and current) 7.8% to 9.9% respectively  Sub-clinical Deficiencies Serum Retinol level <0.74 (µmol/l) among pre-school children & their mothers NHS1998 NNS2001- 2002 Children Severe retinol level<0.35 µmol/l (%) 3.3% 0.8% Children Moderate retinol level b/w 0.35-0.7 µmol/l (%) 31.8% 11.7% Mother Moderate retinol level b/w 0.35-0.69 µmol/l (%) 5.9 % rural Urban 6.7% 5.4%  Bio-chemical levels of vitamin A among Mothers Severe(<0.35(µmol/l) 0.5% Moderate(B/w 0.35-0.69) 5.4 % Source: NNS 2001-2002
  • 19. 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 Place of Residence Palpable Visible No Goitre Urban 7.4% 8.9% 83.8% Rural 9.8% 14.1% 76.3% National 8.9% 12.2% 79.1% Palpable goitre% Visible % No Goitre Urban 2.1% 1.9% 96.0% Rural 5.8% 2.6% 91.6% National 4.4% 2.3% 93.3%  Prevalence of goitre among school-aged children 6-12 years
  • 20. 20 Pre school Children 37.1% (Serum Concentrations< 60 µ/dl Zinc level) Pregnant Women 41.4% (mother of children under five) d) Prevalence of Zinc Deficiency (NNS 2001-2002)
  • 21. 21  Sub Clinical Signs (urinary excretion levels) a) Thiamine Adults 0.87% Children 1.85% b) Riboflavin adults 0.25% children 0.71% e) Vitamin B Deficiencies Source: NNS 1985
  • 22. 22 2.2 Childhood Morbidity as an indicator  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% a) Prevalence of vitamin D Deficiency among children upto 59 months b) Prevalence of Diarrhoea among Children National level 25% Urban 20.8% Rural 27.5%
  • 23. 23 0% 20% 40% 60% 80% 100% Percent urban Male & Female LOW Middle High Female LOW Middle High Male 2.3 Overweight and Obesity as indicators of Malnutrition Source: (NHS 1998) Obese Overweight Desirable Underweight Severe thin
  • 24. 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. 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. 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 Source: (NHS 1994) 0 10 20 30 40 50 60 70 Obese Overweight Normal Underweight Thin Percent urbanPercent rural Female Male MaleFemale * * 0 10 20 30 40 50 60 70 Obese Overweight Normal Underweight Thin
  • 27. 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. 28 2.5 Other Health Diseases Common a) Chronic Bronchitis caused by Tuberculosis & Chronic Obstructive Pulmonary Disease (COPD) Rural Women(age 65 and above) 14% Rural Men 6% Urban(both sexes) 9% b) 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. 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. 30 3.1 Average Intake of Food by Mothers-by Food Groups Food Groups Rural Urban National Total Cereals 357 320 342 Wheat 338 297 322 Rice 18 23 20 Pulses & Legumes 26 24 25 Fat & Edible Oils 28 28 28 Meat 68 78 72 Egg 10 16 13 Tubers & Roots (Including Potato) 41 50 45 Leafy Vegetables 57 58 57 Vegetables 42 48 44 Fruits 22 26 24 Milk/Milk Products 98 78 90 Sugar 56 52 55 N 379 242 621 grams/person/day Source:NNS 2001-02
  • 31. 31 3.2 Average Intake of Food by Children-by Food Groups Food Groups Rural Urban National Total Cereals 235 271 226 Wheat 174 156 165 Rice 61 61 61 Egg 2.5 1.4 1.9 Meat 29 33 31 Milk/Milk Products 229 233 231 N 379 242 621 3.3 Types of Wheat Bread Consumed by Regions Region N Roti Khameeri (Hot Plate) Roti Pateeri (Hot Plate) Roti Pateeri (Baked) Nan (Baked) National Urban Rural 621 242 379 17 12 18 68 71 65 10 10 10 5 7 5 Grams/child/day Source: NNS 2001-02
  • 32. 32 Most frequent Foods used N Once Twice 3-4 times 5-6 times Daily All Meat Urban Rural National 242 379 621 23 30 27 25 20 22 18 12 14 3 2 2 5 2 4 Chicken Urban Rural National 242 379 621 35 33 34 19 12 15 9 8 9 1 1 1 1 10 7 Milk/Milk Products Urban Rural National 242 379 621 17 13 14 5 8 7 7 6 6 2 2 2 24 24 24 Carrots Urban Rural National 242 379 621 3 5 4 1 1 1 2 2 2 0 1 1 1 0 1 Green Leafy Vegetables Urban Rural National 242 379 621 36 31 33 18 19 19 10 16 14 1 4 3 6 5 5 Wheat Bread Urban Rural National 242 379 621 7 2 4 6 2 3 5 5 5 15 13 14 82 85 84 3.4 Consumption Frequency of Different Food Items Per Week Percent Source: NNS 2001-02
  • 33. 33 3.5 Pakistan Food Basket Based on (2100 calories) Average Caloric Requirement/ Capita/ day (proposed) (at physiological Level) Sl. Food Item Quantity (gm) 1. Wheat (Atta) 300 2. Rice 60 3. Other Cereals 15 4. Pulses 30 5. Meat & Products, Poultry & Fish. 40 6. Milk and Milk Products 150 7. Added Fat 30 8. Sugar 50 9. Fruits and Vegetables 100
  • 34. 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. 35  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 4.2 Ongoing Nutrition programmes and Projects
  • 36. 36  World Health Organization  Micronutrient Initiative (MI) US aid Supported Programme  FAO  British Council  DFID  Save the Children Fund  Unicef  Unesco 4.3 International Organizations (working on Food,Nutrition and Health)
  • 37. 37  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 4.4 EDUCATIONAL INSTITUTES IMPARTING NUTRITION EDUCATION AND RESEARCH
  • 38. 38  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 4.5 NON-GOVERNMENT ORGANIZATIONS(working on nutrition & health)
  • 39. 39  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 4.6 GOVERNMENT stake holders (working on Different Nutrition Programmes)  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. 40  Under Nutrition  PEM in Infants and Children  Poverty  Illiteracy and lack of nutritional sp. awareness  Poor Sanitation  Rising Unemployment viza viz price instability  Maternal malnutrition  Young girls  Dietary imbalances  Early marriages  Frequent pregnancies  Non-affordability of health food due to poverty  Inflation(Low purchasing power)  Rural/Urban disparities  Cultural Norms  Micronutrient disorders • Anemia • IDD • Vitamin A deficiencies • Zinc  Lack of awareness  Excessibility and affordability to nutritional foods(Iodized salt,fortified foods)  Non-bioavailability of some important nutrients  Dietary Norms  Resistance to diet modification  Vitamin D deficiency  Lack of awareness  Over weight/Obesity Leading to diet related chronic diseases such as cardiovascular disease, hypertension, diabetes,Renal and dental carries  Excess to extra calories(Fat and simple sugar based)  Reduced physical activities  Cultural Norms  Lack of low cost health clubs  Casual attitude on middle and old age Nutritional health 4.7 Summary of Nutritional Problems and Underlying Causes:
  • 41. 41 5. Pakistan’s Vision for Food Based Dietary Guide lines a) Healthy Balanced Diet for average Pakistani
  • 42. 42 6. Pakistan’s Vision for Food Based Dietary Guide lines b) Healthy Balanced Diet for average Pakistani Child