Malnutrition in
Pakistan
Consequences,
causes, prevention, control
Introduction
Malnutrition
is a pathological condition resulting from deficiency of one or more nutrients.
Cellular imbalance between the supply of nutrient and energy and body demands
for them to ensure growth maintenance and specific function.
o Stunting is very low height for age affecting children deprived of micro nutrients. Means height of a child is not increasing with age. stunting is associated with delayed development and impaired cognitive function.
o
Wasting refers
to low weight for height where a child is thin for his height but not
necessarily short.
Current status of
malnutrition in Pakistan
o
44 - 40.2 % children were stunted.
o
17.7% children wasting
o
In Pakistan 45% death is caused by
malnutrition.
o
Overall 55% population of Pakistan are
malnourished.
o
19% of children are malnourished due to
diarrhea.
o
9.8% are overweight.
o
28.9% are underweight
Micro nutrient deficiency
o
Under five age 28.9% are iron deficient.
o
18.6% of children having zinc deficiency
due to diarrhea.
o
12.1% of under-five age children have
severe vitamin A deficiency caused night blindness and 39.8% moderate vitamin
deficiency
o
13.2% severe deficiency of vitamin D
deficiency and 49.5% moderate deficiency of vitamin D.
o
Under
5 age children are anemic 48% moderate anemia and 5.7% severe anemia.
o
56% of girl anemic and 41.7% anemic in
reproduction age.
Nutritional
disorder having long lasting effects in Pakistan
Pakistan
as a developing country inadequate food intake is secondary to insufficient or inappropriate
food supplies, in some areas cultural and religious
food customs
may paly a role.
Who is vulnerable to under nutrition?
Groups vulnerable to under nutrition typically include
those with increased nutrient requirements (children, pregnant and lactating
women).
However, risk of under nutrition is related to more
than just physiological vulnerability. older people the disabled people with
chronic illness and people living with HIV and AIDS.
Disorder
which effect body long lasting:
Iron- Deficiency
Anemia
Anemia
is a condition where either the numbers of red blood cells or their oxygen
carrying capacity is inadequate to meet an individual physiological need.
Nutritional Anemia
A
condition in which the hemoglobin content of blood is lower than normal as a
result of deficiency of one or more essential nutrients regardless of cause of
such deficiency. In children cognitive development not properly and brain not
developed.
Protein energy
malnutrition
Inadequate
nutrient disorder includes Kwashiorkor and Marasmus.
o Kwashiorkor
is
the wet protein energy malnutrition this condition usually appears around 12
months at time of discontinuous od=f breast feeding.
o Marasmus
caused
by total calorie depletion characterized by stunted growth wasting of muscle
and tissue at 6 months to 1 years in children who weaning from breast milk.
Maternal
malnutrition
Adequate
weight gain during pregnancy important determinant of
fetal growth development. Being underweight mother result newborn will be small
for gestational age and if obesity result overweight baby having excessive fat
and more risk having diabetes in later stage.
Causes of
Malnutrition
Immediate
cause
o Reduced dietary intake.
o Reduces
absorption of macro and micro nutrients
o Increased
losses or altered requirements
o Increased
energy expenditure in specific disease processes.
Underlying
causes
o
Food insecurity
o
Inadequate care and poor public health.
Basic
causes
o
Political, legal and cultural fact
Intervention to
improve malnutrition
There are some intervention to improve the status of malnutrition as a developing
country.
1.
Awareness about Perceptional nutrition
We
know the pregnancy period is most important time to take care or mother and
infants but as a nutritionist we should educate and aware the women about their
perceptional nutrition because it is easy to develop storage of many nutrients
before pregnancy than after .the time period shortly before and after
conception when new baby conceive in uterus this is the critical period
when nutritional and other exposure can effect the conception, pregnancy
maintenance , growth development and future health of infant and offspring. If
mother is deficient in vitamins and other minerals it effects the baby growth
and development and in case of any abnormality it will irreversible.
2.
Micro-nutrient intake during periconceptional
We
know it is very difficult to educate every woman about periconceptional period
but there are some major nutrients which deficiency leads toward the
malnutrition of infants.
·
Folate status
present in cereal, rice bean, spinach women should increase the intake of these
vegetable after her marriage RDA of folate is 400mcg. Deficiency of folic acid
during pregnancy leads toward preterm delivery, baby can be small for
gestational age, and neural tube defects.
·
Iron status as
we know 41.7% of girls are anemic in reproductive age so increase the iron
intake through iron enriched food or supplementation because it is easier to
develop iron store before pregnancy than after pregnancy. RDA of iron is
18mg/day.
·
Vitamin A high
dosage of vitamin A through food supplement or treatment of acne leads towards
the abnormality of fetus or miscarriage.
·
Iodine deficiency cause
impairment of mental and physical development.
3.
Enhanced Breastfeeding practices
Breastfeeding
is a critical nutrition intervention for improving both dietary quality and
quantity for children. breast milk alone meets all of nutritional needs of
infants up to six months of age in addition to providing immunological and
psychological benefits. a mother diet affects the both mother and her children.
o
Exclusive breastfeeding for the first six
month is vital for preventing has one of lowest EBF rates in south Asia. after
six months start feed iron-fortified cereals and pureed and mashed meats.
Below
1 year’s cow milk not recommended.
4.
Stop child marriages
Food
insecurity and malnutrition can be both causes and consequences of child
marriage. Girl who are married young experience higher rates of anemia and
malnutrition that those who marry later in life.
Children
born to adolescent mothers are more likely to have low birth weight, suffer
from poor nutritional status and experience stunting this may be due to part to
maternal-fetal competition for nutrients and energy since adolescent mothers’
bodies are still growing and developing themselves.
5.
Water sanitation and hygiene
Malnutrition
concerns not as enough food the wrong type of food and the body responses to a
wide range of infection that result malabsorption of nutrients.
Water
sanitation and hygiene given their direct impact on infectious disease
especially diarrhea is important for preventing malnutrition. Both are linked
to poverty
Clean
water in environment friendly plastic bottle should provide by health services
or introduce water sanitation services in rural areas which is cheap and
affordable or should be free to poorer family this reduce the maternal mortality,
ending preventable newborn deaths and providing quality.
6.
Proper vaccination in rural areas
Lack
of vaccination in rural areas have many factors firstly the rural areas people
are uneducated about vaccination than urban areas .and other factor is that the
staff of services misconduct vaccination in rural areas the reasons for delayed
vaccination a greater fraction of urban mothers and differences were statically
significant.
Mother
illness and forgetting about next vaccination appointment child sickness and
following physician recommendation were significantly less likely to be the
reason for delayed vaccination in rural children as compared with urban
residents.
7.
Food fortification
The
populations most risk of such deficiencies are infants and children, women and
the elderly lack of dietary diversity poor minerals bioavailability in plant
foods incidence of illness and disease and increased physiological demands are
the main contributors to micronutrients.
o
Iron fortification Such
as iron-fortified milk and cereal among deficient children has been reported to
reduce morbidity from infectious disease , severe iron deficiencies is more
prevalent in developing countries like Pakistan ,fortification is the best
solution because fortified food can easily available and cheap .in Pakistan
mostly iron fortification done in wheat flour which is staple food which is
available to everyone.
o
Iodine fortification iodide
salt is introducing to reduce the iodine deficiency such as goiter,
hypothyroidism
8.
Increase the agriculture production
Government
should use of modern agriculture techniques to increase the agriculture
production.
Staple
food should available at very cheap rate. The food should enough to fulfill the
every person needs .and education of food is must important as the developing
country we facing poverty that’s why the nutrition is not the first priority
for us so government should increase the crops yield and production so the hunger is maintained in every class of people where they are poor or
upper class.
When
every person has enough food so there is less chances of malnutrition.
9.
Emergency school feeding
School
feeding program should introduce in rural areas where children avail the
nutrient based foods which effects the health and reduces the risk of
under nutrition, every school should introduce this service and should examine
the children under observation of health care services.
10.
Improve food safety
National
legislation and regulation to meet the international food safety, incidence of
food born disease reduced by 50%. access of the poor to healthy safe food
increased by 50%.
Proper
education to peoples regarding importance of food .
Factor affecting
iron absorption
o
Vitamin C increase the iron absorption
such as grapefruit kiwi oranges and strawberries with iron riches foods are
beans dark green leafy vegetable
o
Meats fish and poultry also increase iron
absorption
o
Calcium is the antagonist of iron
absorption
o
For infants exclusive breastfeeding till 6
month and start feed iron fortified cereals and pureed meats
Treatment of
MARASMUSS and KWASHIOKOR
o
Adequate nutrition
o
Restore normally body composition
o
Correction of fluid and electrolytes
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