Stop stunting: Pakistan perspective on how this could be realized†

Globally, nearly half of all under-five deaths annually (3million deaths) are attributable to undernutrition, as malnutrition is associated with increased risk of morbidity and infections, which leads to mortality (Liu et al. 2015). In 2011, at least 165million children worldwide were stunted, and 52million were wasted, with higher prevalence in south Asia and subSaharan Africa. Malnutrition is not confined to children but is also rampant among women of reproductive age. This maternal malnutrition contributes to fetal growth restriction, which leads to low birthweight and increases risk of childhood infections and mortality. Children exposed to these risks early in life have a higher risk of growth faltering and stunting, which can cause long-term irreversible and detrimental cognitive, motor and health impairments (Black et al. 2013). Most of the irreversible damage due to malnutrition occurs during gestation and in the first 24months of life, hence underscores the importance of intervening in this period. Malnutrition is widespread in Pakistan among all ages, and the progress has not been encouraging over the last decade. One-third of children in Pakistan are underweight, 44% are stunted, 15% are wasted, half of them are anemic, and almost one-third of the children have iron deficiency anemia (Table 1) (Government of Pakistan 2011). There is prominent inequity between the nutritional indicators of urban and rural populations, and children from the poorest wealth quintile are faring the worst. Among women, 14% of women of reproductive age are thin or undernourished (BMI less than 18.5 kg/m), and this prevalence is highest among the poorest, uneducated and ruraldwelling women. Micronutrient deficiencies are also prevalent among women with half of the women anaemic and high rates of vitamin A, zinc and iron deficiencies (Government of Pakistan 2011). Figure 1 shows that stunting prevalence varies greatly within Pakistan’s districts, ranging between 22% and 76%. The lowest figures for wasting and underweight were both less than 2.5% and the highest were 42% for wasting and 54% for underweight (Di Cesare et al. 2015). Current recommendations for improved infant and young child nutrition (IYCN) include initiation of breastfeeding within 1 h of birth, exclusive breastfeeding of infants until 6months of age, introduction of safe and nutritionally rich foods in addition to breastfeeding at about 6months of age and continued breastfeeding with complementary feeding until 2 years of age or older. All IYCN indicators in Pakistan are ‘undesirably low’ even when compared with other countries in the South Asian region. Pakistan is conspicuous for having the lowest rates for early initiation of breastfeeding, exclusive breastfeeding rates and timely initiati on of complementary feeding (Table 2); and the highest rate in the region for bottle feeding. Latest data suggest that immediate breastfeeding is initiated in 18% of all births, whereas exclusive This perspective paper was commissioned by the guest editors of this special supplement of Maternal and Child Nutrition to bring countryspecific perspectives to the issue of stunting in South Asia. It has not been peer reviewed. The views in this paper are the authors’ views and do not necessarily reflect the views or policies of their organizations