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