Islamabad
Despite having been historically self-sufficient in food supply, Pakistan faces severe nutritional challenge. Feeding and eating patterns of women in Pakistan are better only for very limited phases leaving rest of the life compromised by under-nutrition due to knowledge deficit about proper diet, says a recently conducted study.
Speaking to The Nation, Dr Arjumand Faisel, principal investigator of the research, said, “We have a national curriculum that must be followed. Health care workers should be trained according to NNC and given the diet plan in plastic card forms to advise the correct quantity of food for each age group. There are no complexities in it, rather, it is a simple diet plan that everybody can easily understand and follow.”
The research “Understanding the Current Feeding and Eating Patterns of Low-Income Females of 0-49 years, the Knowledge Deficit about Proper Diet and Possible Nutrition Education Interventions” funded by the Maternal and Newborn Health Programme - Research and Advocacy Fund (RAF) probed what are females currently eating in Pakistan in comparison to what they should be minimally eating (daily food intake) to maintain good health, as recommended by the National Nutrition Curriculum (NNC).
It discovered that the feeding and eating patterns in females were better only during the phases of birth to early complementary feeding, pregnancy, and lactation (but only in postpartum period). While in the remaining period of life, the daily dietary intake remains below the recommended levels of NNC, both in terms of quantity and quality of foods. Hence the vicious cycle of low birth weight (LBW) babies, undernourished mothers, LBW babies continues.
Although there is close link between poverty and nutritional status, there is also strong evidence that poverty alone is not entirely responsible for undernutrition and with knowledge of proper food the nutritional status can be improved. There is substantial deficit of knowledge about diet of females from one year onwards till pregnancy and after the end of postpartum period.
Identifying knowledge deficits that lead to unsatisfactory practices, the study explores that nutrition interventions can be introduced effectively. The community-based health workers are the main influencers for bringing a positive change in the feeding and eating patterns. But, unfortunately, they are being trained on nutrition education only on a few phases of life of a female.
Besides these community-based health workers, there are very limited sources, such as TV and radio, in the ‘ecology of learning’ of females in the low income communities that can reach them, be respected and acceptable to them, and can bring the desired change in feeding/eating patterns. The most preferred source by low-income community women for gaining knowledge for improving the diet of females of all ages is a female trained in nutrition.
Lady Health Workers (LHWs) and Community Midwives (CMWs) can more effectively bring change in the feeding and eating patterns of the low-income households by gaining the confidence of mothers and mothers-in-law and providing them with nutrition-related information of female family members. Talking to husbands during the door-to-door visits also can complement and enhance the change process.
The study recommends that in order to break the cycle of under-nutrition, nutrition programmes should give importance to feeding and eating patterns throughout the life of a female, and should not be restricted to a few phases.
The study explores that nutrition programmes (implemented through various cadres of workers) had been successful in convincing the low-income women for giving mothers’ milk as the first item to the newborn soon after birth. However, the practice of giving ghutti which includes honey, desi ghee and water in different forms as the first item continues by a noticeable portion of the population. Ghutti is sometimes mixed with ingredients like asafetida (heeng), ammonium chloride (noshadar) and excessive salt, which can be harmful to the baby.
Delaying breastfeeding till the second or third day due to various misconceptions and beliefs is still prevalent and it becomes worrisome that only a few women in the low income groups are doing exclusive breastfeeding, the research states.
Moreover, some women are still delaying complementary feeding at the recommended age of six months up to 3 months and few are delaying it up to 7-9 months. A very important consideration of adding ghee or oil to the weaning food for increasing the caloric value, without increasing the bulk, is not being considered anywhere.
NNC recommends that “all table foods” should be introduced at the age of 10-12 months, however, women normally introduce them from 12-18 months and sometimes even at 24 or 30 months. Hence, feeding of family diet is being delayed for a noticeable proportion of female children, leading to initiation of inadequate food intake from this early age. Also, several food items containing proteins, carbohydrates and vitamins are avoided, adding to the inadequacy of intake.
From 2 years to 10 years, female children consume the routine meals along with other family members of the household. There is deficiency in intake of proteins, energy rich foods and vitamins. The LHWs, leading cadre of community-based health workers, lack knowledge about the quantity to be given and the inclusion of four food groups in the diet.
The nutritional status of adolescent girls is critical to their growth and development, and in preparation for their future role as mothers. In contrast to the recommendation of NNC, most low-income families in the study districts are not making any special changes in the diet of girls from 11 to 18 years. Their diet remains deficient in protein rich, energy rich foods and vitamins.