Micronutrient Malnutrition (MNM) is a widespread disease in both industrialized and developing countries but is adversely affecting the latter. These nutrients are required by the body in small amounts for normal growth but despite having a minuscule demand by the body, deficiency in any of these nutrients results in serious health complications. These nutrients are synthesized by the body in very small amounts hence they should be provided through diet.

The most common forms of these micronutrients are Iron, Vitamin A, D and Iodine and a deficiency of any of these nutrients causes malnutrition, and another problem called “Hidden Hunger”

Hidden hunger is a phenomenon caused by the lack of these essential nutrients and shows that it is possible to be overweight and still be malnourished. According to the World Health Organization (WHO), together these affect at least one third of the world’s population, the majority of which are in developing countries. Of the four, iron deficiency is the most prevalent. It is estimated that just over 2 billion people are anemic, just under 2 billion have inadequate iodine nutrition and 254 million preschool-aged children are vitamin A deficient.

Food fortification is the addition of micronutrients to the processed foods. This strategy can lead to relatively fast improvement in the status of micronutrients in a body, if advantage is taken of the existing technology, this process can be carried out at a reasonable cost. The only requirement is that the fortified products must be consumed in adequate amounts. Food fortification increases and supports current nutrition improvement programs as well. This is by far the most cost-effective nutrition intervention, particularly when produced by medium- to large-scale industries. Targeted fortification (e.g., nutrient-fortified complementary foods for children 6-24 months) is important for nutritionally vulnerable population subgroups such as infants, young children, women of reproductive age, and populations in emergency situations whose nutrient intake is insufficient through available diets. Targeted fortification is also effective in resource-poor settings where family foods lack animal sources that are typically necessary to meet the nutrient requirements of young children.

Fortification is one of the most common and important process, specifically for children. Milk is the most consumed food item by children. It is fortified by adding Vitamin A and D in specific amounts. One of the most important benefits of fortified milk is that it allows vitamin D to naturally improve the absorption rate of Calcium that is present in the milk. Vitamin D also improves skeletal balance and maintains the level of Calcium in the blood. Consuming adequate amount of Vitamin D and Calcium prevents a deformity or softening of bones such as rickets and osteomalacia, one of the most common diseases caused by MNM. It also lessens the chances of getting osteoporosis later in life.

One of the biggest steps that Pakistan has taken is the launch of “Food Fortification Program” by UK’s Department for International Development. The program includes fortification of wheat flour and edible oil and ghee across Pakistan starting in Punjab. It aims to improve the production, access and consumption of wheat flour fortified with iron, folic acid, vitamin B12 and Zinc, and edible oil and ghee fortified with vitamins A and D.

Given the widespread prevalence in Pakistan of deficiencies in iron and in vitamins A and D, food fortification strategies offer a tangible option for delivering these micronutrients on a large scale.

Malnutrition is not only confined to children but is also rampant among women of reproductive age suffering from anemia, usually related to iron deficiency as well as wasting among poorer communities that are food insecure. Maternal malnutrition not only leads to increased risk of mortality among women but also contributes to fetal growth restriction (small size of the baby during pregnancy) that, in turn, multiplies the risk of growth faltering and stunting in childhood. The latter can cause long-term detrimental cognitive, motor and health impairments.

In Pakistan, malnutrition is widespread among all ages, and progress to address social determinants over the last several decades had been very slow. According to the National Nutrition Survey 2011, one-third of all children are underweight, nearly 44pc are stunted, 15pc are wasted, half of them are anemic and almost one-third of these children have iron deficiency anemia.

These rates have hardly changed over two decades according to the findings of a maternal and child nutrition study group published by Lancet in 2013. Notable differences can be found between the nutritional indicators of urban and rural populations; children among the rural and urban poor are at greatest risk. Among women, 14pc in the reproductive age bracket are thin or wasted (with a body mass index less than 18.5 kg/m2) and this prevalence is highest among households that are food insecure.

These differences in maternal and child malnutrition are also remarkable among various provinces and sub-regions, and clustered in areas widely recognized as high-risk districts

Additionally, a major contributor to childhood malnutrition is the overall poor state of infant and young child feeding. Pakistan is conspicuous for having the lowest rates for the early initiation of breastfeeding, exclusive breastfeeding rates and timely initiation of complementary feeding, and the highest rate in the region for bottle-feeding.

Despite the established benefits of early and exclusive breastfeeding, even among the poorest families, work pressure, lack of breastfeeding support and ignorance leads to the administration of alternative fluids such as tea and even animal milk.

Data from the Pakistan Demographic and Health Survey (2012-2013) suggests that immediate breastfeeding is initiated in 18pc of all births, whereas exclusive breastfeeding is carried out for only 38pc of infants younger than six months.

Regular monitoring and accountability is critical if Pakistan is to break the logjam for addressing malnutrition. There is a need to ensure regular data on nutrition indicators with more discrete regional or district level information.

The situation is ripe for change with greater current emphasis on nutrition and formulation of various national and provincial nutrition focused strategies.

Also, there is need for integrating various different sectors and programs to achieve the desired results effectively and efficiently as many of the determinants and influencing factors are outside the health sector.


The writer is the first Sikh to be elected as a member of the Punjab Assembly. He has served as a member of the National Commission for Minorities and Chairman of Standing Committee on Commerce & Investment.