COUNTRY PRESENTATION
An Overview
Of
Food,Nutrition & Health
in
Islamic Republic of Pakistan
Intercountry Technical Consultation on National Food based
Dietary Guidelines.6th to 9th Dec.2004
WHO-EMRO,Cairo,Egypt
Presented By:
Prof.Dr.Perveen Liaqat
1
COUNTRY INTRODUCTION
2
Demographic Indicators
Population
Population Growth Rate
130.580 million (PCP 1998)
140
million (Economic Survey03-04)
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)
3
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
4
1.1 Adequacy of Food
1.
Food Production
a) Major Food Crops
Production of major Food Crops (000 Tonnes)
Years
Sugar Cane
1999-00
46333
2000-01
Rice
Maize
Wheat
5156
1652
21079
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)
Source: (Economic Survey of Pakistan 2003)
5
Wheat Production (000 Tonnes)
22000
20000
18000
16000
14000
Rice Production (000 Tonnes)
12000
5500
03-04(P)
3-Feb
2001-02
00-01
99-00
98-99
97-98
96-97
95-96
94-95
93-94
92-93
91-92
90-91
10000
5000
Rice Production (000 Tonnes)
4500
4000
3500
3000
Sugarcane Production (000 Tonnes)
2500
60000
-0
2
3Fe
b
03
-0
4(
P)
-0
1
01
-0
0
20
00
-9
8
-9
7
-9
6
-9
5
-9
4
-9
3
-9
1
-9
9
99
98
97
96
95
94
93
92
91
90
-9
2
2000
55000
50000
45000
40000
35000
(P
)
b
-0
4
03
-0
2
3Fe
-0
0
-9
9
-9
8
-9
7
-0
1
01
20
00
99
98
97
96
-9
6
95
-9
5
94
-9
4
93
-9
3
92
-9
2
91
90
-9
1
30000
Source: Economic Survey 2003
6
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
Source: (Economic Survey of Pakistan 2003)
7
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%
8
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%
9
2.
Food Consumption
Food availability per Capita
Items
Units
1997-98
Cereals
Kg
159.7
Pulses
Kg
Sugar
1998-99
1999-2000
2001-2002
171.0
163.5
149.3
5.9
6.8
7.2
6.1
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
Per capita availability of calories and Protein
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)
10
1.2 Ample access to Food
1.
Poverty
Trends in Food Poverty Incidence
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
Source: PIDE 1998-99 PSES primary data &Food security analysis 2003
11
2.
Unemployment
Unemployment
7.8%
Source: (Economic Survey of Pakistan 2003)
3.
Lack of Nutrition awareness and Education
12
1.3 Reliability of both Supply and Access
1.
Inequity in land holdings
40% total farm area
7% landowners
60% total farm area
93% farmers
•
2.
Landowners have more access to water for irrigation,
fertilizers and other resources
Inequity in food supply in different provinces
13
2. Nutrition Indicators of Malnutrition
i. Low Birth weight
ii. Childhood Growth
a)
Time trend in prevalence of stunting,wasting & underweight
Source
NSWP
MNS
NNS
NHS
NNS
1965
1977
1985-7
1990-4
2001-2
-
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
Year
Underweight
b)
Prevalence of Stunting & Wasting among Gender
Source
Year
NHS
NNS
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%
14
c)
Prevalence of Stunting and Wasting among Rural/Urban
children under five.
Source
Year
NHS
NNS
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%
15
iii. BMI as Nutrition Indicator during Pregnancy & Lactation
 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
16
2.1 Prevalence of Micronutrient Deficiencies as Malnutrition Indicators
a) Prevalence of Iron Deficiency Anemia
Iron deficiency Anemia among Children under five & their Mothers
Moderate
Severe
Children
33.0%
2.6%
Mothers
23.7%
1.8%
17
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 (mol/l) among pre-school children & their mothers
NHS1998
NNS20012002
Children
Severe retinol level<0.35 mol/l (%)
3.3%
0.8%
Children
Moderate retinol level b/w 0.35-0.7 mol/l (%)
31.8%
11.7%
Mother
Moderate retinol level b/w 0.35-0.69 mol/l (%)
5.9 %
rural
Urban
6.7%
5.4%
 Bio-chemical levels of vitamin A among Mothers
Severe(<0.35(mol/l)
0.5%
Moderate(B/w 0.35-0.69)
5.4 %
Source: NNS 2001-2002
18
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%
 Prevalence of goitre among school-aged children 6-12 years
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%
19
d) Prevalence of Zinc Deficiency (NNS 2001-2002)
Pre school Children
37.1%
(Serum Concentrations< 60 /dl Zinc level)
Pregnant Women
41.4%
(mother of children under five)
20
e) Vitamin B Deficiencies

Sub Clinical Signs (urinary excretion levels)
a) Thiamine
Adults
0.87%
Children
1.85%
b) Riboflavin
adults
0.25%
children
0.71%
Source: NNS 1985
21
2.2 Childhood Morbidity as an indicator
a) Prevalence of vitamin D Deficiency among children
upto 59 months

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%
b) Prevalence of Diarrhoea among Children
National level
25%
Urban
20.8%
Rural
27.5%
22
2.3 Overweight and Obesity as indicators of Malnutrition
Percent urban Male & Female
100%
Obese
Overweight
80%
60%
Desirable
40%
20%
Underweight
Severe thin
0%
LOW
Middle High
Female
LOW Middle High
Male
Source: (NHS 1998)
23
2.4 Chronic Diseases Related with Overweight and Obesity
i. Serum Cholestrol level
ii. Blood pressures and Hypertension
iii. Non-insulin dependent diabetes
24
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
25
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
Percent rural
Percent urban
70
60
50
40
30
20
10
0
70
60
50
40
*
30
20
*
10
0
Obese
Obese
Female
Overweight
Normal
Underweight
Male
Overweight
Normal
Underweight
Thin
Thin
Female
Male
26
Source: (NHS 1994)
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)
27
2.5 Other Health Diseases Common
a)
b)
Chronic Bronchitis caused by Tuberculosis & Chronic
Obstructive Pulmonary Disease (COPD)
Rural Women(age 65 and above)
14%
Rural Men
6%
Urban(both sexes)
9%
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
28
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
29
3.1 Average Intake of Food by Mothers-by Food Groups
grams/person/day
Food Groups
Rural
Urban
National
Total Cereals
357
320
342
Wheat
Rice
338
18
297
23
322
20
Pulses & Legumes
Fat & Edible Oils
Meat
Egg
Tubers & Roots (Including Potato)
Leafy Vegetables
Vegetables
Fruits
Milk/Milk Products
Sugar
26
28
68
10
41
57
42
22
98
56
24
28
78
16
50
58
48
26
78
52
25
28
72
13
45
57
44
24
90
55
N
379
242
621
Source:NNS 2001-02
30
3.2 Average Intake of Food by Children-by Food Groups
Grams/child/day
Food Groups
Rural
Urban
National
Total Cereals
235
271
226
Wheat
Rice
174
61
156
61
165
61
Egg
Meat
Milk/Milk Products
2.5
29
229
1.4
33
233
1.9
31
231
N
379
242
621
3.3 Types of Wheat Bread Consumed by Regions
Region
National
Urban
Rural
N
Roti Khameeri
(Hot Plate)
Roti Pateeri
(Hot Plate)
Roti Pateeri
(Baked)
Nan
(Baked)
621
242
379
17
12
18
68
71
65
10
10
10
5
7
5
Source: NNS 2001-02
31
3.4 Consumption Frequency of Different Food Items Per Week
Percent
Most frequent Foods used
All Meat
Urban
Rural
National
Chicken
Urban
Rural
National
Milk/Milk Products
Urban
Rural
National
Carrots
Urban
Rural
National
Green Leafy Vegetables
Urban
Rural
National
Wheat Bread
Urban
Rural
National
N
Once
Twice
3-4 times
5-6 times
Daily
242
379
621
23
30
27
25
20
22
18
12
14
3
2
2
5
2
4
242
379
621
35
33
34
19
12
15
9
8
9
1
1
1
1
10
7
242
379
621
17
13
14
5
8
7
7
6
6
2
2
2
24
24
24
242
379
621
3
5
4
1
1
1
2
2
2
0
1
1
1
0
1
242
379
621
36
31
33
18
19
19
10
16
14
1
4
3
6
5
5
242
379
621
7
2
4
6
2
3
5
5
5
15
13
14
82
85
84
Source: NNS 2001-02
32
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)
2.
Rice
60
3.
Other Cereals
15
4.
Pulses
30
5.
Meat & Products, Poultry & Fish.
40
6.
Milk and Milk Products
7.
Added Fat
30
8.
Sugar
50
9.
Fruits and Vegetables
300
150
100
33
4. Food and Nutritional National policies
4.1 Existing
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
34
4.2 Ongoing Nutrition programmes and Projects

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
35
4.3 International Organizations (working on Food,Nutrition and Health)

World Health Organization

Micronutrient Initiative (MI) US aid Supported Programme

FAO

British Council

DFID

Save the Children Fund

Unicef

Unesco
36
4.4 EDUCATIONAL INSTITUTES IMPARTING NUTRITION EDUCATION
AND RESEARCH









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
37
4.5 NON-GOVERNMENT ORGANIZATIONS(working on nutrition & health)





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
38
4.6 GOVERNMENT stake holders (working on Different Nutrition Programmes)

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

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
39
4.7 Summary of Nutritional Problems and Underlying Causes:
 Poverty


Under Nutrition
PEM in Infants and Children
 Illiteracy and lack of nutritional sp. awareness
 Poor Sanitation
 Rising Unemployment viza viz price instability
 Maternal malnutrition
 Dietary imbalances
 Young girls
 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
 Excess to extra calories(Fat and simple
Leading to diet related chronic
diseases such as cardiovascular disease,
hypertension, diabetes,Renal and dental
carries
sugar based)
 Reduced physical activities
 Cultural Norms
 Lack of low cost health clubs
 Casual attitude on middle and old age
Nutritional health
40
5. Pakistan’s Vision for Food Based Dietary Guide lines
a)
Healthy Balanced Diet for average Pakistani
41
6. Pakistan’s Vision for Food Based Dietary Guide lines
b)
Healthy Balanced Diet for average Pakistani Child
42