Voice Of Children

Karachi

Prof Aisha Mehnaz, an eminent pediatrician and chairperson of the Department of Pediatrics, Dow University of Health Sciences and Civil Hospital, Karachi, has voiced concern over increasing levels of malnutrition in Pakistan.

The News conducted an interview with her on Saturday about the likely impact of the rising inflation and the withdrawal of subsidies on the vast majority of the people of Pakistan, particularly the poorest of the poor. Excerpts follow:

Q: Given the fact that 30 percent of Pakistan’s population is condemned to live below the poverty line and inflation is at the highest ebb, how can the common man combat malnutrition?

A: Pakistan is the 6th most populous country in the world with a population of over 178 million and has some of the worst health indicators in the world. Fifty percent of its population comprises children, and 31 percent of them are under five years.

Ninety-four out of 1,000 children do not reach their 5th birthday and 78 out of 1,000 do not complete even the first year of life.

Pakistan has one of the highest levels of under nutrition and malnutrition in the world. In Pakistan, 30.3 percent of children under five years are underweight, 40.9 percent are stunted, 16.8 percent are severely wasted and 62 percent are anaemic.

The super floods of 2010 and 2011 have further worsened the situation. Our nutritional programmes have failed to address the problem because the root causes of poverty, illiteracy and socioeconomic deprivation have been largely ignored .The common man lacks the knowledge to combat malnutrition. Though the rapidly deteriorating economic condition is much to blame, in my opinion it is the poverty of knowledge regarding food and its nutritive value that is the main cause. Very few people have the knowledge that food grain available at home such as rice and lentils, if cooked with plenty of oil with addition of vegetables such as spinach and potato etc. can become a very wholesome and balance diet. Fruits such as dates and bananas are not only rich in energy but are a good source of vitamins and minerals such as potassium, thus a very healthy food for those living in warm climates such as ours.

Q: Please enlighten The News on the importance of breastfeeding and injurious effects of bottle feed.

A: Breast milk is the inherent birthright of every child. Mothers who deny breastfeeding are violating the rights of the child as well as God’s command. In the Holy Quran it is clearly stated that babies should be giving mother’s milk till two years of life. Breast milk is species’ specific, i.e. human milk is good for human child and cow’s milk for calves.

This is because of the fact that human child is in the process of maturation even after birth and his systems such as renal system is still immature. Giving whole cow’s milk will place an electrolyte load on yet immature kidney of babies. Unlike human child, cow’s young one begins to graze soon after birth and their renal system is mature. Mother’s milk is thus tailor-made to the species of its own kind. Besides providing nutrition, human milk has anti-infective properties by virtue of which babies are protected from infections. Breast milk is the first vaccine a baby needs to be given even before the BCG and polio vaccine.

Regarding bottle feeding a number of studies have shown a direct correlation of bottle feeding with diseases such as diarrhea, ear infection, asthma and allergies.

A recent study published in a reputable journal has shown that children who are breastfed have a much higher IQ level compared with children who were given animal milk or were bottle-fed. This shows a direct effect on brain growth and intellectual performance in children fed on human milk.

Q: Ninety percent of diseases are waterborne. Given the fact that most of Pakistan’s population is condemned to drink contaminated water, what steps should be adopted to make water safe?

A: It does not need very sophisticated means to purify water. Simply boiling the water, particularly, the drinking water and hand-washing, observing all the essential steps of hand-washing will decrease the waterborne diseases considerably. The government should also ensure water purification and decontamination of water supplied to the population. Vaccines against some waterborne infections such as typhoid and rotavirus are available and these should be included in the EPI programme of Pakistan and particularly be given to children.

Q: Health and education has always been a low priority in Pakistan. Given the fact that health budget is minuscule, how can we meet challenges in the domain of health and education?

A: Unless health and education is given priority, we cannot imagine a healthy and educated Pakistan. If the government is not willing to take a positive step, then philanthropist and non-governmental organisations (NGOs) should play a proactive role. This does not mean that the state will be exempted from this. Thus the onus will still lie with the government.

Q: Don’t you agree that participatory development can help meet the abovementioned challenges, especially when we are forced to withdraw subsidies?

A: I think to some extent it will; at least, it will be a good beginning.

Rawalpindi

According to estimates, nearly 50 million people in Pakistan are suffering from iodine deficiency while 70 per cent of the total population in the country is at risk of Iodine Deficiency Disorders.

Studies reveal that more than five million children born every year in Pakistan are unprotected against brain damage while 36 per cent mothers and 23 per cent pre-school children are suffering from iodine deficiency in Pakistan. Pakistan is rated 6th among the countries where iodine deficiency is a serious health problem.

Although according to National Nutrition Survey (NNS) 2011, 79 per cent people in Punjab province are consuming iodised salt as compared to 17 per cent in 2001, still it is low when compared with countries with similar socio-economic conditions like Nepal where 98 per cent of the total population consumes iodised salt.

Professor and Head of Community Medicine at CMH Lahore Medical College Professor Dr Muhammad Ashraf Chaudhry expressed this while talking to ‘The News’ in connection with Global Iodine Deficiency Disorder Day being observed on October 23. He said that Iodine is essential for the normal growth, development and well being of all humans. The whole spectrum of health consequences casually linked to iodine deficiency is collectively known as Iodine Deficiency Disorders (IDDs). IDD is most commonly seen among poor, pregnant women and preschool children. Groups most susceptible to iodine deficiency include children below two years of age, he said.

Dr. Ashraf explained that the Global Iodine Deficiency Disorder Day is an awareness campaign to educate the people on how hard the effects of iodine deficiency can fall on you if you are not careful enough. Though IDD has lowered in number over the years due to iodisation of salt and awareness programs, even today one sixth of the world population is still under the risk of the disorder, he said.

He said that the effects of IDD on the baby in the mother’s womb are in the form of congenital abnormalities (defects by birth), early deaths, brain damage, cretinism and deafness; effects on the child and adolescent are goitre (enlargement of thyroid gland), impaired mental function, stunted physical growth, short stature and diminished school performance; whereas effects of iodine deficiency on women are in the from of decreased fertility, spontaneous abortions and still births in pregnant women.

To a query, Dr. Ashraf said that Iodine deficiency can result in loss of 15 IQ points. “The main factor responsible for iodine deficiency is a low dietary supply of iodine.”Talking of remedies, he said that to prevent iodine deficiency, it is very important to educate people about the Iodine Deficiency Disorders that they and their children might get if not careful about their diet and nutrition. The addition of small amount of iodine to table salt in the form of potassium iodate at very little cost can help prevent the incidence of this serious disorder, he said.

He added that seafood is also a known source of iodine. Other sources of iodine are bread, grains, green vegetables, drinking water, milk (especially cow milk) and eggs. Daily requirement of iodine for adults is placed at 150 micrograms per day or 5 gram (1 teaspoonful) of iodized salt per day. The most viable option is having Universal Salt Iodization (USI) of edible salt across the country, he said.

He said that for children up to six months, iodine supplementation should be given through breast milk. This implies that the child is exclusively breastfed and the lactating mother should receive iodine supplementation, said Dr. Ashraf.

He said that there are specific situations, such as emergencies, among displaced people and geographically remote areas, where iodized salt may not be accessible. In these specific situations, increasing iodine intake should be provided in the form of iodine supplements for pregnant and lactating women, and a supplement or complimentary food fortified with iodine for children 6-23 months of age, he said.

He added that there is a dire need to create mass awareness on this issue and mount advocacy for promotion of IDDs legislation and monitoring of the enforcement of Universal Salt Iodisation at production, retail and community levels in order to combat iodine deficiency in the country. Trainings and capacity building of salt processors at the district level is also required.

However, concerted efforts of civil society organizations including health professionals, teachers, religious leaders, social workers, salt producers, processors and policy makers are required in partnership to overcome this challenge, said Dr. Ashraf.

He said that medial community can play a vital role in advocacy for the usage of iodized salt at the gross-root level. Medical professionals can make people aware of the consequences of iodine deficiency and dispel any myths, disbeliefs or misconceptions associated with the use of iodised salt, he said.

He suggested that new plans to strengthen salt iodization that include increasing political commitment and advocacy are strongly needed. The hospitals and nursing units should take part in the awareness program which can reduce disorders and retardation. Awareness programs, talk shows and photo exhibits can all help in reducing the Iodine Deficiency Disorder in the country, concluded Dr. Ashraf.