名古屋学芸大学健康 ･ 栄養研究所年報

創刊号

２００７年

《Review》

Nutritional Problems in Pakistan
Allah Nawaz Memon＊

Abstract
The nutritional problems in Pakistan are discussed. Malnutrition is prevalent among people in Pakistan.
Particularly, malnutrition in infants, leading to high infant mortality, is caused by poverty, inadequate hygienicconditions, poor maternal nutrition and lack of understanding of proper weaning diet on the part of mothers. Therefore, the improvement of educational opportunities for women is of utmost importance to combat
malnutrition in Pakistan.

GEOPOLITICS OF PAKISTANPakistan, officially the Islamic Republic of Pakistan, is a country located in South Asia and the Greater
Middle East. It has a thousand-kilometer coastline along the Arabian Sea in the south and borders Afghanistan
and Iran to the west, India to the east and Peoples Republic of China in the far northeast.
Pakistan is the sixth most populous country in the world with the population of about 160 million. It wasestablished as a modern state in 1947, as one of the two parts of the partitioned British India, but East Pakistan
was separated from Pakistan to become Bangladesh in 1971.
Pakistan is a federation of four provinces Punjab, Sindh, Balochistan and North-West Frontier (NWFP).
The provinces are subdivided into many districts which contain numerous tehsils and local governments.

AGRICULTURE
Pakistan is an agricultural country; the main crop is cotton which is exported on large scale and, within
Pakistan, many textile mills produce a variety of cloth.
The staple food of Pakistan is wheat and rice. Some parts of Sindh, Balouchistan and mountainous areas
often suffer from water shortage. In case of a drought, people migrate to some other areas for search of food;they are employed as labourers to purchase foods. People will eat whatever is available to them and very little
thought is given to the importance of acquiring nutrients and caloric intakes.

POVERTY INCIDENCE IN PAKISTAN
Poverty alleviation is the most persistent challenge facing Pakistan since its inception. According to thePakistan Socio-economic Survey (2001), the proportion of poor families in the urban area is 30% and that
＊ Professor and Director, Institute of Biochemistry, University of Sindh, Jamshoro, Pakistan＊ Visiting scientist in School of Nutritional Sciences, Nagoya University of Arts and Sciences (2002)
Key words: Pakistan, Food Intake Habit, Malnutrition, Poverty, Education55

in the rural area amounts to 40%. This trend has stayed unchanged more than past 40 years. The underlying
factors that create and perpetuate poverty involve a number of dimensions; e.g., income inequality, unemployment, inadequate access to basic services and resources, inadequate distribution of assets, technology andsocio-economic opportunities, and underdeveloped infrastructure, etc.

EDUCATION
The literary rate of Pakistan is about 40%. Most of Pakistan people is labourers and farmers and theycannot afford education and do not send their children to schools although there are many primary schools,
secondary schools, colleges and universities in the country. The media of instructions in most of the primaryand secondary schools are Urdu and Sindhi; English is used in the colleges and universities.
Each province has medical, agricultural, science and arts universities, but, generally speaking, universities
in urban districts are better facilitated than those in rural area.
Serious problem is poor opportunity of education for females mainly due to economic conditions; womenin rural area suffer more than urban area

ENVIRONMENTAL AND HYGIENIC CONDITIONSThe environmental conditions in Pakistan are poor; the air is polluted with industrial exhaust and wastematerials. Everywhere, we observe lack of sanitation facilities, improper disposal system of solid waste, lackof safe drinking water, and lack of awareness about health and nutrition. The use of contaminated water andexposure to polluted environment increase the risk of diseases such as diarrhea, dysentery, malaria, respiratoryinfections, influenza, and hepatitis.
It is estimated that 45% of the total population in Pakistan do not have access to health services, 40%
are deprived of safe drinking water and 53% are living without sanitation facilities ( M.U. Haq and K. Haque,
Human Development in South Asia, Human Development Centre, Islamabad, 1998). According to the reportby Pakistan Institute of Developmental Economics (Islamabad, 2001), 20-30% of children of 1-5 years age
group have an episode of diarrhea during last two weeks. During the course of a year, the average children
may experience 5-12 episodes of diarrhea.

FOOD INTAKE HABITS IN PAKISTAN
The food intake in Pakistan is usually for three times a day; i.e. breakfast, lunch and dinner. In breakfast,people usually take chappati/roti/bread. Some also take paratha (rati with fat), egg, yoghurt butter and tea. Inlunch, people take chappati/nan/roti with vegetable/lentils. Some take meat/chicken/fish along with whey/yoghurt and pickles. At dinner, people take almost the same diet as in lunch with the addition of milk and sweat
dishes.
It is generally observed that people eat whatever food is available to them and very little thought is given
to the importance of acquiring necessary nutrients or calories. The food habits depend on the agricultural
products they produce and also according to their social and economic status.

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Nutritional Problems in Pakistan

PREVALENCE OF MALNUTRITIONIn Pakistan, despite an increase in per capita food availability and resultant rise in calorie and protein
intakes, the prevalence of malnutrition has not improved over last 20 years (National Health Survey, 1996).
At the time of the on-set of the Ninth Plan, i.e. 1997-98, the estimated number of malnourished children was
about 8 million. Nearly half of the children under five years of age were found underweight of age at a levelthat corresponds to general malnutrition of protein energy malnutrition (PEM). Approximately 5% of these areseverely underweight and 10% were moderately underweight. The major nutritional problems are low birthweight due to poor maternal nutrition, protein energy malnutrition, anemia, iodine deficiency disorders andother micronutrient deficiencies. The adverse nutritional status can partly be explained by the sustained levelsof mass poverty and income inequality and, to some extent, the behavioral aspects relating to the attitudes ofgender bias.
The nutritional status depends on the availability of food and the intake of balanced diet, assessed byclinical, anthropometric and biochemical tests. The nutritional status of the pregnant women is not different
from that of children. They give birth to malnourished babies. These babies are 10 times more likely to die as
infants and those who survive remain malnourished and become sick due to infectious diseases.
High prevalence of anemia among women between ages 15-44 years is an important reason of the lowbirth-weight babies. Nearly 9 million children less than 5 years old are anemic in Pakistan. The causes ofanemia other than nutrient deficiency include malaria, intestinal parasites and thalasemia. The immune system
is adversely affected by the iron deficiency that raises morbidity from infectious diseases. Iodine deficiency
in women results in still births, birth defects, mental retardation and child death. In Pakistan, about 40 million
people are considered iron deficient. Goitre prevalence is 20% in school-age children.
The high estimates of malnutrition reflect the prevailing weaning practices, especially among the children
under the age of 12 months. For many children, mother’s milk provides the main source of nourishment during
the first year of life. However at the age of 4-5 months, it should be supplemented by additional foods richin protein and other nutrients. The National Health Survey (1996) found that foods other than the breast milk
begin at approximately 7.6 months of age in Pakistan. This indicates that most of the mothers in Pakistan are
not aware of children’s proper diet according to their age. The lack of education among women is strongly
associated with malnutrition among children.
During a recent survey of dietary habits of working (in-service) and non-working (housewives) females
in Pakistan (F. Memon, M. Phil. Thesis, Sindh University), it was observed that many of the housewives weretaking only a cup of tea in the morning. On the query about the breakfast, the reply was that they do not haveenough time, or they do not like to have the breakfast at all. On the other hand, most of the working females
were regularly taking the breakfast. Since working women are educated, they are aware of the importance ofbalanced diet which is essential for their mental as well as physical health. Here again, the education plays animportant role in the adequate intakes of nutrients.

FUTURE PROSPECTS
From the foregoing discussion, it is clear that the improvement in the nutritional states of people in Pakistan
requires many factors; i.e. increase in food supply, reduction of poverty through well-targeted programs, creationof awareness about hygiene through community health programs, provision of health facilities, availability ofclean potable water, and above all, provision of universal education to eradicate illiteracy.

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和文抄録

Nutritional Problems in Pakistan
Allah Nawaz Memon＊

パキスタンの栄養問題を概説した。多数のパキスタン国民、特に乳幼児の高死亡率を齎す栄養不足は貧困および不完全な衛生状態などに起因するが、とりわけ文盲率60％以上とされる教育の貧困が基本にある。乳幼児の低栄養は、妊娠中の母親の低栄養、出産後の離乳食に対する理解不足などが原因と思われる。これらの問題を解決するためには、食糧供給の改善、貧困の克服、衛生設備および知識の普及に加えて教育、特に女性教育の普及が急務である。

＊ Professor and Director, Institute of Biochemistry, University of Sindh, Jamshoro, Pakistan

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