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Please contact UNICEF Pakistan, Nutrition Section All Rights Reserved: UNICEF Pakistan Photographs: UNICEF Pakistan Designed by Human Design Studios NATIONAL NUTRITION SURVEY 2018 - KFR 2 Introduction The 2018 Pakistan National Nutrition Survey (NNS 2018), the largest national nutrition survey, in Pakistan.
It is designed to provide to 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.

NATIONAL NUTRITION SURVEY 2018 - KFR l d e p m a S l d o h e s u o H 4 For the biochemical assessment, 31,828 blood samples for WRA and 31,828 samples for children were planned to analyse.
For water quality a sample size of 31,828 was estimated based on the prevalence of coliform and E. coli contamination of water.
Planned Survey Sample Blood Samples Urine Samples Province/ Region PSUs HHs Water Samples WRA Children WRA Children Balochistan 794 15,880 7,297 7,297 745 745 7,297 KP 807 16,140 5,096 5,096 807 807 5,096 KP-NMD 377 7,540 2,070 2,070 377 377 2,070 Punjab 2,051 41,020 7,704 7,704 2,051 2,051 7,704 Sindh 945 18,900 5,656 5,656 945 945 5,656 ICT GB AJK 68 1,360 340 340 68 68 340 328 6,560 2,640 2,640 190 190 2,640 410 8,200 1,025 1,025 597 597 1,025 Grand Total 5,780 115,600 31,828 31,828 5,780 5,780 31,828 NATIONAL NUTRITION SURVEY 2018 - KFR CHILDREN UNDER FIVE YEARS OF AGE 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.
6 NUTRITIONAL STATUS OF CHILDREN UNDER FIVE YEARS OF AGE • STUNTING • UNDERWEIGHT • WASTING • OVERWEIGHT In Pakistan, four out of ten children under five years of age are stunted while 17.7% suffer from wasting.

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 among children under five has almost doubled over seven years, increasing from 5% in 2011 to 9.5% in 2018.

Prevalence of Malnutrition (Children Under Five) Prevalence of Malnutrition by Locality (Urban/Rural) Stunted Wasted 34.8% 16.2% Underweight 24% Overweight 9.6% RURAL NATIONAL NUTRITION SURVEY 2018 - KFR 7 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.

Prevalence of Malnutrition by Gender NATIONAL NUTRITION SURVEY 2018 - KFR 8 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.
Prevalence of Stunting by Province/Region The prevalence of stunting improved from 1965 (48%) to 1994 (36.3%) but deteriorated from 2001 (41.6%) to 2011 (43.7%).

In 2018, at 40.2%, it remains at a global critical level.

The average annual reduction rate is estimated at 0.5%, too slow to significantly reduce the stunting rate in Pakistan.
Trends of Stunting in Pakistan NATIONAL NUTRITION SURVEY 2018 - KFR 9 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.
Prevalence of Wasting by Province/Region 11% 10.8% 11.8% 5 6 9 1 : P W S N 7 - 5 8 9 1 : S N N 4 - 0 9 9 1 : S N N 8.6% 7 9 9 1 : S N M 17.7% 14.3% 15.1% 1 0 0 2 : S N N 1 1 0 2 : S N N 8 1 0 2 : S N N Trends of Wasting in Pakistan This form of malnutrition is most prevalent in Sindh (23.3%) and KP-NMD (23.1%), whereas GB and ICT have the lowest proportion of children with wasting, at 9.4% and 12.1% respectively.

Sindh, Balochistan and KP-NMD have a higher prevalence of wasting than the national average.
The prevalence of wasting among children under five in all provinces/regions excluding ICT and GB exceeds the emergency threshold (15%).

NATIONAL NUTRITION SURVEY 2018 - KFR 10 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.
Prevalence of Underweight by Province/Region 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.
Prevalence of Overweight by Province/Region NATIONAL NUTRITION SURVEY 2018 - KFR 11 MICRONUTRIENT DEFICIENCIES IN CHILDREN UNDER FIVE YEARS OF AGE Anaemia in Children Under Five 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%).

Trends of Anaemia in Pakistan The prevalence of anaemia has been consistently high since 2001 when it stood at 50.9%, then rose to 61.9% in 2011, and declined to 53.7% in 2018.
NATIONAL NUTRITION SURVEY 2018 - KFR 12 Iron Deficiency Anaemia Among Children Under Five The prevalence of iron deficiency anaemia is Zinc Deficiency Among Children Under Five The prevalence of zinc deficiency is 18.6%, 28.6% with a slightly higher proportion (29.1%) with similar proportions among boys and girls.

among boys than girls, and in rural (28.9%) Rural children have a slightly higher prevalence than urban populations.

(19.5%) than those in urban areas (17.1%).


Vitamin A Deficiency Among Children Under Five About 51.5% of children have vitamin A deficiency, of whom 12.1% have a severe deficiency.

Prevalence is slightly higher (51.7%) among boys than in girls (51.3%).

Vitamin D Deficiency Among Children Under Five A high prevalence (62.7%) of vitamin D deficiency was observed.

A significant proportion (13.2%) of children have a severe deficiency.

The prevalence is slightly higher (63.1%) among girls than boys (62.4%).
NATIONAL NUTRITION SURVEY 2018 - KFR 13 PROGRAMME COVERAGE DEWORMING Only 13.1% children aged 24–59 months were reported to have been given deworming medication in the six months prior to the survey, with lower coverage in urban (10.7%) than in rural (14.5%) settings.

Deworming by Locality (Urban/Rural) Deworming by Province/Region Coverage of deworming medication is highest in GB (14.2%) and Punjab (14.1%) and lowest in ICT (6.5%) and KP-NMD (6.7%).
NATIONAL NUTRITION SURVEY 2018 - KFR 14 INFANT AND YOUNG CHILD FEEDING (IYCF) PRACTICES • BREASTFEEDING • COMPLEMENTARY FEEDING 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.
BREASTFEEDING 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%.
Breastfeeding Trends Nearly half (45.8%) of Pakistani babies start breastfeeding within the first hour of birth, an Early initiation of breastfeeding (within first hour of birth) 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.
NATIONAL NUTRITION SURVEY 2018 - KFR Early Initiation of Breastfeeding (within first hour of birth) by Province/Region 15 The practice of early initiation of breastfeeding varies from 20.1% in GB to 61.1% in Balochistan.

Early Initiation of Breastfeeding (within first hour of birth) by Wealth Quintile There is no significant correlation found between wealth and early initiation of breastfeeding.
NATIONAL NUTRITION SURVEY 2018 - KFR 16 Exclusive Breastfeeding by Province and Region The proportion of children who are exclusively breastfed for the first six months of life is highest in KP (60.7%) and KP-NMD (59.0%), and lowest in AJK (42.1%) and Balochistan (43.9%) respectively.

Breastfeeding Practices in Pakistan Prevalence of the practice of continued breastfeeding is highest at one year of age (68.4%) and thereafter decreases to 56.5% at two years of age.
Relative to the rates in 2011 this represents a decrease from 77.3% and an increase from 54.3%, respectively.

NATIONAL NUTRITION SURVEY 2018 - KFR 17 COMPLEMENTARY FEEDING PRACTICES IN PAKISTAN Age-appropriate complementary feeding is an essential addition to breastfeeding after a child is six months of age.

Quality complementary feeding is measured using three indicators: minimum dietary diversity, minimum meal frequency and minimum acceptable diet.
NNS 2018 found all indicators to be far below acceptable levels.

Age-Appropriate Complementary Feeding by Gender Only one of every three young children receives complementary food between 6–8 months of age.

A smaller proportion of boys (34.6%) are introduced to complementary food at the right age compared to girls (37.3%).

Some provinces/regions (Sindh and KP-NMD) perform better than others but timely introduction of complementary feeding needs significant improvement in across Pakistan.
NATIONAL NUTRITION SURVEY 2018 - KFR 18 Age-Appropriate Complementary Feeding by Province/Region NATIONAL NUTRITION SURVEY 2018 - KFR Complementary Feeding in Pakistan 19 By Locality (Urban/Rural) NATIONAL NUTRITION SURVEY 2018 - KFR 20 Complementary Feeding Practices by Province/Region Over time, three of the four complementary indicators have declined significantly.
This points to a need for robust and large-scale promotion of adequate complementary practices in Pakistan to contribute to reducing stunting among young children.

Only one in seven children (14.2%) aged 6–23 months receive a meal with minimum dietary diversity, with at least four different food groups.

One in four children (18.2%) receives the minimum number of meals a day.
Complementary foods that meet the requirements of a minimum acceptable diet to ensure optimal growth and development for children aged 6–23 months are provided to less than one in 20 children (3.6%).

More children in urban areas receive adequate complementary foods than their peers in rural areas, but rates are critically low in both localities.
NATIONAL NUTRITION SURVEY 2018 - KFR Trends in Complementary Feeding 21 All complementary feeding indicators are far below acceptable levels NATIONAL NUTRITION SURVEY 2018 - KFR 22 DISABILITY AMONG CHILDREN AGED 24-59 MONTHS The Washington Group on Disability Statistics determines functional disability among children aged 2–5 years based on six core functional domains.

NNS 2018 found that 12.7% children have a functional disability in one of these six domains.
Around 1.2% demonstrate functional disability in seeing, 1.5% in hearing, 2.6% in walking, 4.5% in remembering, 8.5% in selfcare and 5.6% in communication.

Functional Disability Among Children Aged 24-59 Months In Pakistan, boys are more likely to have a functional disability related to remembering.

For all other types of functional disability, boys and girls are equally affected.
Functional Disability Among Children Aged 24-59 Months by Gender NATIONAL NUTRITION SURVEY 2018 - KFR ADOLESCENT GIRLS & BOYS (10-19 YEARS) About two-thirds of the sampled adolescent girls aged 10–19 years (62.9%) lived in rural areas and 37.1% in urban areas.

The majority of girls (94.7%) in the survey sample were never married while 5.2% were currently married.

A large proportion (38%) of adolescent girls belonged to the two highest wealth quintiles.
Of the sampled adolescent boys (10–19 years) 63.5% lived in rural areas and 36.5% in urban areas.

24 ADOLESCENTS NUTRITION (10-19 YEARS) Nutritional Status of Adolescent Girls and Boys NNS 2018 shows that almost one in eight adolescent girls is underweight.

Adolescent boys are more affected than adolescent girls, with one in five underweight.

More adolescent girls are overweight compared to their male peers, at 11.4% and 10.2% respectively.
Obesity is a public health issue of concern in Pakistan, with 7.7% of adolescent boys and 5.5% of adolescent girls affected.

Overweight and obesity affect adolescents similarly in both rural and urban areas of Pakistan.
NATIONAL NUTRITION SURVEY 2018 - KFR Nutritional Status of Adolescent Girls and Boys by Locality (Urban/Rural) 25 NATIONAL NUTRITION SURVEY 2018 - KFR 26 Across all of Pakistan’s provinces/regions, the double burden of malnutrition – high prevalence of underweight combined with high prevalence of overweight or obesity – is a major concern and requires serious consideration to curb the incidence of noncommunicable diseases.
Nutritional Status of Adolescent Girls by Province/Region Anaemia Among Adolescent Girls Haemoglobin Status Among Adolescent Girls More than half (56.6%) of adolescent girls in Pakistan are anaemic, however only 0.9% have severe anaemia.

Adolescent girls in rural areas are more likely (58.1%) to be anaemic than their counterparts in urban areas (54.2%).
NATIONAL NUTRITION SURVEY 2018 - KFR 27 Nutritional Status of Adolescent Boys (BMI) by Province/Region NATIONAL NUTRITION SURVEY 2018 - KFR WOMEN OF REPRODUCTIVE AGE (WRA) (15-49YEARS) Overall, 61.2% of the sampled WRA belonged to rural settings and 38.8% to urban areas.

Nearly half (48.5%) were not educated while 15.5% had received higher education and 14.5% had completed secondary education.

Most of the sampled WRA (72.0%) were housewives with only 1.9% skilled workers and 1.7% professionals.
Most sampled WRA (21.3%) came from the richest wealth index quintile and only 17.8% belonged to the poorest quintile.

30 WOMEN OF REPRODUCTIVE AGE (15-49 YRS) RESPONDENT CHARACTERISTICS In Pakistan WRA aged 15–49 years bear a double burden of malnutrition.

One in seven (14.4%) are undernourished, a decline from 18% in 2011 to 14%, while overweight and obesity are increasing.

In NNS 2011 28% were reported to be overweight or obese, rising to 37.8% 2018.
Urban/rural disparity is apparent: women in rural areas are more malnourished, while overweight and obesity are higher in urban women.

Nutritional Status of WRA (15-49 years) by Body Mass Index (BMI) NATIONAL NUTRITION SURVEY 2018 - KFR 31 Nutritional Status of WRA (15-49 years) by Province/Region At provincial/regional level, Sindh, Balochistan and AJK have more undernourished women while overweight and obesity are more pronounced in ICT, KP and KP-NMD.
NATIONAL NUTRITION SURVEY 2018 - KFR 32 MICRONUTRIENT DEFICIENCIES IN WOMEN OF REPRODUCTIVE AGE (15-49 YRS) Anaemia among Women of Reproductive age About 41.7% of WRA are anaemic, with a slightly higher proportion in rural (44.3%) than urban settings (40.2%).

Trend Analysis in Anaemia NATIONAL NUTRITION SURVEY 2018 - KFR 33 Vitamin D Deficiency The majority of WRA (79.7%) are affected by vitamin D deficiency, with 54.0% experiencing moderate vitamin D deficiency and 25.7% experiencing severe deficiency.
Vitamin D deficiency is more common in urban (83.6%) than in rural settings (77.1%).

Vitamin A Deficiency in Women Age 15-49 Years Over a quarter of WRA (27.3%) are deficient in vitamin A, with 22.4% experiencing moderate and 4.9% severe deficiency.

This is more prevalent among WRA in rural settings (29.3%).

Balochistan (34.6%) has the highest proportion of WRA with vitamin A deficiency.
NATIONAL NUTRITION SURVEY 2018 - KFR 34 Iron Deficiency Anaemia in WRA - 15-49 Years About 18.2% of WRA are iron deficient.

This is more pronounced among women residing in rural (18.7%) than urban (17.4%) settings.

Sindh has the highest proportion of iron deficiency anaemia with about a quarter (23.8%) of all WRA affected, followed closely by Balochistan (19.0%) and Punjab (18.7%).

Calcium and Zinc Deficency About 26.5% of WRA are hypocalcaemic while 0.4% are hypercalcaemic.
Zinc deficiency (22.1%) is more common in rural settings (24.3%) than in urban areas (18.7%).

Punjab has the highest proportion of WRA with zinc deficiency (24.1%) followed by Balochistan (23.4%) and Sindh (21.4%), while KP has the lowest prevalence (15.9%).

Urinary Iodine Excretion About 17.5% of WRA have urinary iodine deficiency.

Of these, 12.9% have moderate and 4.6% have severe deficiency.
Both severe and moderate urine iodine deficiency is more prevalent in women in rural areas (18.6%) than in urban areas (16%).

NATIONAL NUTRITION SURVEY 2018 - KFR UNIVERSAL SALT IODIZATION IN PAKISTAN Salt samples were taken from 100,304 households across provinces/regions and were tested using rapid test kits to identify adequately iodized salt (≥15 ppm and <40 ppm iodine).

Of these, 70.2% were rural households and the remainder urban.
36 UNIVERSAL SALT IODIZATION IN PAKISTAN Iodine is essential for thyroid function and for physical and mental development.

Daily use of adequately iodized salt is the best strategy to overcome iodine deficiency disorders.

Across Pakistan, almost four out of five households consume iodized salt.

A greater proportion of households in urban settings consume iodized salt compared to households in rural areas.
Use of Iodized Salt at HH Level Use of Iodized Salt at HH Level by Province/Region Consumption of iodized salt is very low (31.6 percent) in KP-NMD.

By contrast, in ICT, Punjab, AJK and GB, consumption of iodized salt exceeds 85%.

Urinary Iodine Excretion (UIE) Among Children Aged 6-12 Years Low urinary iodine excretion is a reliable indicator of iodine deficiency.
The survey showed that 15.7% of children aged 6–12 years have low urinary iodine excretion, with a slightly higher rate amongst girls (16.2%) than boys (15.2%).

Prevalence of low urinary iodine excretion is slightly higher among rural children (16.9%) than urban children (14.0%).
NATIONAL NUTRITION SURVEY 2018 - KFR NUTRITION SENSITIVE SECTORS A total of 96,307 people lived in households that were assessed for food insecurity using the Food and Agriculture Organization’s Food Insecurity Experience Scale (FIES), which captures self-reported food-related behaviours and experiences associated with increasing difficulties in accessing food due to resource constraints.

Drinking water sample was collected from 31,828 households to determine water quality.
38 FOOD SECURITY More than half of households (63.1%) are “food secure” on the FIES measure, however over third (36.9%) remain food insecure.

A larger percentage of households are food secure in GB (75.6%) and KP (70.9%) and experience less severe food insecurity than in Balochistan (50.3%) and KP-NMD (54.6%).
Household Food Insecurity Based on FIES Pakistan NATIONAL NUTRITION SURVEY 2018 - KFR Household Food Insecurity by Province and Region 39 National Nutrition Survey 2018 NATIONAL NUTRITION SURVEY 2018 - KFR 40 WATER, SANITATION AND HYGIENE (WASH) Drinking water from 56.1% of households in Pakistan is contaminated with coliforms, with a slightly higher rate in rural (57.3%) than in urban areas (54.2%).

The highest prevalence of coliform contamination is in ICT (92%) and the lowest in GB (12%).
About 36.0% of households in Pakistan drink water contaminated with E. Coli, with a slightly higher rate in urban (37.4%) than rural areas (35.2%).

The highest prevalence of E. Coli contamination is in KP-NMD (78.3%) and the lowest in Punjab (30.4%).

NATIONAL NUTRITION SURVEY 2018 - KFR Household Using Improved Sources of Drinking Water 41 Over nine out of ten households (92.6%) in Pakistan have access to improved sources of drinking water.
There is some disparity in urban and rural populations, and variations between provinces/regions.

Balochistan has the lowest proportion of households with access to improved sources of drinking water (75.3%).

Percentage Using Improved Sources of Drinking Water by Province NATIONAL NUTRITION SURVEY 2018 - KFR 42 Household Using Improved Sanitation Facility Urban dwellers have more access to improved sanitation facilities (95.8%) than their counterparts in rural areas (78%).
Almost 85% of households in Pakistan have access to an improved sanitation facility.

Household Using Improved Sanitation Facility by Province/Region ICT (98.2%) and Punjab (92.7%) have the highest proportion of households with access to an improved sanitation facility and are thus closest to eliminating open defecation.

Most other provinces/regions are on track to eliminate open defecation with a slower rate of progress, while KP-NMD (57.9%) and Balochistan (67%) lag behind on this indicator.
NATIONAL NUTRITION SURVEY 2018 - KFR 43 Children whose Last Stools were Disposed off Safely Child faeces are more infectious and contaminating of the environment than adult faeces, but the perception of people in Pakistan is the opposite.

As such, safe disposal of child faeces is low across Pakistan with only 38.5% households using a safe method.

Safe disposal is poor overall across Pakistan.


Children whose Last Stools were Disposed of Safely by Province/Region Safe disposal of child faeces is low in all provinces/regions with the highest rate in Punjab (41%).

The lowest rate is to be found in KP-NMD (24.2%).


NATIONAL NUTRITION SURVEY 2018 - KFR 44 Handwashing at Five Critical Times in Pakistan by Locality (Urban/Rural) An encouraging proportion of the population practices handwashing with soap and water at five critical times (over 96% depending on the practice).

There is little disparity between urban and rural populations.
NATIONAL NUTRITION SURVEY 2018 - KFR Handwashing at Five Critical Times by Province/Region 45 Handwashing with soap and water at five critical times, is widely practiced in all provinces/areas.

AJK leads the trend for handwashing before preparing food or eating (97.4%) people.
The widest disparity in practices relates to washing hands before feeding a child, with over 32 percentage points between the highest, KP-NMD and the lowest, GB, and after handling a child’s faeces, with 34 percentage points between the highest, KP, and the lowest, ICT.

Punjab, KP and AJK are ahead of other provinces/regions in washing hands with soap.

Handwashing after defecation is practiced by most Pakistanis, from 79.4% in Balochistan to 95.6% in AJK.
NATIONAL NUTRITION SURVEY 2018 - KFR 46 SOCIAL PROTECTION Population Covered under Social Protection by Locality (Urban/Rural) NATIONAL NUTRITION SURVEY 2018 - KFR Population Covered under Social Protection by Province/Region 47 NATIONAL NUTRITION SURVEY 2018 - KFR 48 ACRONYMS AJK GB HH ICT IYCF KP Azad Jammu and Kashmir Gilgit-Baltistan Household Islamabad Capital Territory Infant and young child feeding Khyber Pakhtunkhwa KP-NMD KP Newly Merged Districts NNS PSU WRA National Nutrition Survey Primary sampling unit Women of reproductive age NATIONAL NUTRITION SURVEY 2018 - KFR