Matrix Report
In Pakistan, 4 out of 10 children under five years of age are stunted while 17.7% suffer from wasting. This was reported in the Pakistan National Nutrition Survey (NNS) 2018. The survey was conducted by Agha Khan Hospital in collaboration with Unicef.
The double burden of malnutrition is becoming increasingly apparent, with almost one in three children underweight (28.9%) alongside a high prevalence of overweight (9.5%) in the same age group. The prevalence of overweight amongst children under five has almost doubled over the last seven years, increasing from 5% in 2011 to 9.5% in 2018.
The survey also reveals more than half (53.7%) of Pakistani children are anaemic and 5.7% are severely anaemic. The prevalence of anaemia is slightly higher (54.2%) amongst boys than girls (53.1%). Children in rural areas are more likely to be anaemic (56.5%) than in urban areas (48.9%). A similar pattern was observed for severe anaemia (rural: 5.9%; urban: 5.2%).
The 2018 Pakistan National Nutrition Survey (NNS 2018) is the largest national nutrition survey carried out in Pakistan. It is designed to provide policymakers, programme managers and academicians a unique set of nutrition-related data including environmental, anthropometric and biochemical indicators. The study group included children, women of reproductive age (WRA) and adolescent boys and girls. NNS 2018 is the fifth national nutrition survey since 1965, but the first to yield district-representative data and to include adolescents and a component on water.
NNS 2018 employed a cross-sectional survey design at the household level. It used a mixed-method data collection methodology with both quantitative and qualitative approaches.
The sample design provides district level estimation at the national level for urban and rural localities and by gender, for the four provinces (Punjab, Sindh, Balochistan and Khyber Pakhtunkhwa, KP); and for the regions (Azad Jammu and Kashmir, AJK, and Gilgit-Baltistan, GB), KP-NMD and Islamabad Capital Territory (ICT).
A national, province and district representative sample of 76,742 children (aged 0–59 months),
145,847 adolescents (10–19 years) and 145,324 WRA (15–45 years) was selected from 115,600 households.
A total of 68,493 mothers/caretakers of children under five were interviewed. Of these, 24,209 children under two years were assessed for infant and young child feeding (IYCF) practices. Of these children, 50.9% were boys and 49.1% girls. About 36.4% lived in urban localities and 63.6% in rural areas. About 55.8% of the mothers of the sampled children were illiterate and 42.5% children belonged to the lowest two wealth quintiles.
The pattern of distribution of malnutrition among boys and girls remains the same, with boys being more affected than girls by all forms of malnutrition. Children living in urban areas suffer more from undernutrition (wasting, stunting and wasting) than their peers in rural areas. Overweight affects children equally, irrespective of locality.
Stunting
Stunting is a major problem in Pakistan, with 12 million children with low height for age. To ensure that this form of malnutrition does not continue to compromise the human capital required to sustain the socioeconomic development of Pakistan, stunting reduction is a top national priority.
The national average (40.2%) masks provincial disparities. The prevalence of stunting varies from 32.6% in ICT to 48.3% in KP-NMD. The prevalence of stunting among young children in Sindh, Balochistan, KP-NMD and GB is higher than the national average.
WASTING
Since 1997, the prevalence of low weight for height among young children is on the rise, from 8.6% in 1997 to 15.1% in 2011 and 17.7% in 2018. Despite improvements in other socioeconomic indicators, acute malnutrition remains in a state of nutrition emergency. This is the highest rate of wasting in Pakistan’s history.
UNDERWEIGHT
The prevalence of underweight among children under five years of age (i.e. weight for age below 2 z-score) is high in all provinces/regions, from 19.2% in ICT to 41.3% in Sindh. The prevalence of underweight is below 20% only in ICT.
OVERWEIGHT
The study estimated the proportion of overweight children under five to be 9.5%, twice the target set by the World Health Assembly. Prevalence is highest in KP-NMD (18.7%) and Balochistan (16.7%), and lowest in Sindh (5.2%) and ICT (5.8%). The prevalence of overweight among young children exceeds 10% in KP, Balochistan, KP-NMD, AJK and GB.
BREASTFEEDING
NNS 2018 finds that early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding show an upward trend from 2011, but most indicators related to complementary feeding are declining except the proportion of children receiving an adequately diversified diet.
While there has been a steady increase in the proportion of children receiving breastmilk during the first hour after birth between 2011 and 2018, the trend for exclusive breastfeeding is not linear. From 50% in 2001, it decreased to 37.7% in 2011 and increased again to 48% in 2018, bringing Pakistan close to the World Health Assembly target of 50%.
Nearly half (45.8%) of Pakistani babies start breastfeeding within the first hour of birth, an improvement of 6 percentage points from 2011. The practice of early initiation of breastfeeding is only three percentage points higher in urban areas than in rural areas.
