Increasing iron
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THE WHO refers to malnutrition as deficiencies, excesses or imbalances in a person’s intake of nutrients, and not just the insufficiencies. But in South Asia, as in most developing countries, malnutrition is usually seen as the inability to achieve nutrition targets because of the scarcity of available food. Correct and balanced nutrition at the right time is pivotal to children’s survival, health and development.
Pakistan is no different than the rest of South Asia where malnutrition is concerned. In fact, the state reports one of the highest prevalence of child malnutrition as compared to other developing countries. The National Nutrition Survey 2018 has shared alarming findings. According to the report, 40.2 per cent of children under five are stunted while 17.7pc are wasted. The most common nutritional deficiencies among the children are those of iron, Vitamin A, vitamin D, zinc and folic acid. Iron deficiency alone accounts for 49.1pc of the deficiencies in children between six and 59 months. Even more perturbing is the fact that a similar survey in 2011 showed iron deficiency anaemia to be prevalent among 43.8pc of children. Clearly, not much had changed after seven years.
These worsening figures require urgent and concrete remedial steps.
Owing to rapid body growth and depletion of iron stores, iron requirements during the first two years of life are higher than in any other period. This depletion and consequent iron deficiency anaemia can result in growth retardation, impaired cognition and reduced physical activity and is associated with impaired brain and cognitive functions. It has even contributed to the high national infant mortality rate.
Pakistan has one of the highest rates of child malnutrition.
Apart from children, adolescents and women of child-bearing age are also highly vulnerable to iron deficiency. This micronutrient deficiency in women is the biggest reason behind complications during pregnancy and malnourished children later on. Increased iron needs during these periods and decreased iron intake and absorption seem to be the most significant causes.
It has long been observed that the symptoms of iron deficiency anaemia include tiredness, lethargy and fatigue. The social cost of these problems calculated in terms of work output, loss of productivity and poor school performance is a wake-up call. This means that in the longer run, iron deficiency anaemia affects the human resource adversely and has unpropitious effects on the country’s GDP.
A report published in 2015, Analysis of Economic Losses Due to Iron & Folic Acid Deficiencies in Pakistan by Kalimuddin Ghauri, states that the best available global evidence applied to national health, labour and demographic data suggests that depressed national economic activity of nearly one quarter of a billion dollars annually can be attributed to current rates of iron deficiency anemia.
Even though addressing the challenges of malnutrition was on the manifestos of the political leadership, not much has been done on this front. For starters, it is important to note that nutrition education plays a significant role and adults should be taught that infants’ diets should include iron-rich items like apples, egg yolk, spinach and cereals. Another way is to fortify milk and cereal products with iron as this can effectively reduce anaemia in children up to three years of age. Milk is a basic diet for children who are at the right age to start drinking iron-fortified milk.
However, highlighting these facts is simply not enough. Though specific and targeted steps like food fortification, micronutrient supplementation and nutrition education have been initiated, we still have some distance go before we actually start seeing results.
While food fortification is a very important way to address the malnutrition challenges being faced by the country, the federal government needs to prioritise formulating policies that are conducive for the food industry to fortify products beyond salt, wheat and ghee.
Meanwhile, there is a lot of ongoing research worldwide on the ways through which the ingredients and nutritional value of food can be augmented. It is fortunate that we have seen a quantum leap in iron fortification, which addresses iron deficiency without affecting the taste of food and beverages. Referred to as ‘iron-plus’, the improved iron source enables thrice the absorption of iron in human beings as routinely available sources of iron. It is an excellent opportunity for countries like Pakistan to drastically reduce malnourishment in the country. After all, eradicating iron deficiency and malnutrition in Pakistan will need a joint effort from the government, the food industry and the informed masses so that there is hope for the future generations.
The writer is an academic medical researcher and a doctor working for a tertiary care hospital in Karachi.
Published in Dawn, February 15th, 2022
