The Aga Khan University and its partners conducted the largest-ever National Nutrition Survey in Pakistan to provide policymakers, programme managers and academics with a unique set of nutrition-related data that is yielding environmental, anthropometric and biochemical insights.

Stunting continues to be a key problem in Pakistan, affecting four out of 10 children under the age of five, according to the 2018 National Nutrition Survey (NNS). This means that as many as 12 million children, across the length and breadth of the country, are suffering from impaired growth.

The most recent NNS is the fifth such survey since 1965, but the first to provide insights at the district level, enabling stakeholders to pinpoint areas facing the greatest food security and nutrition challenges.

While about 40 percent of children under five in Pakistan are stunted, or too short for their age, the figure is significantly higher in certain areas. For example, more than 48 percent of children are stunted in the newly merged districts of Khyber Pakhtunkhwa (KP-NMD) province. Similarly, parts of Sindh, Balochistan and Gilgit-Baltistan have stunting figures ahead of the national average, whereas the Islamabad Capital Territory fares better, with stunting prevalence standing at 32.6 percent.

Beyond stunting, acute malnutrition is also present in the form of wasting – being too thin for one’s height – with record levels of wasting detected. Sindh and KP-NMD have the highest levels of wasting prevalence at 23.3 percent and 23.1 percent respectively, far higher than the 9.4 percent in Gilgit-Baltistan and the 12.1 percent in Islamabad Capital Territory.

National, provincial and district-level samples captured the health status of 76,742 children under the age of five, 145,847 adolescents and 145,324 women of reproductive age. The study, which spanned 115,600 households, employed a cross-section survey design and a mixed methods approach combining qualitative and quantitative methods to collect data.

Finally, data was categorised by urban and rural localities and divided by gender, enabling researchers to assess factors relating to gender inequality and geographic inequalities.

The study found that while overall there are few gender-specific differences in malnutrition, a disadvantage in nutrition outcomes amongst girls appears by the age of five.

Overall trends also vary by age group. While there is a high burden of undernutrition in children under the age of five, one notices a rising proportion of obesity and overweight in adolescent boys and girls between 10 and 19 years of age.

While children in urban areas suffer more from wasting and stunting than their peers in rural areas, geographic considerations had no impact on being overweight. Compared to findings from the last survey, the prevalence of overweight individuals has almost doubled over seven years.

In the 2018 National Nutrition Survey, for the first time, data was collected on water quality. Over 31,828 water samples across the country were analysed. The study found that 58 percent of household water supplies are contaminated with coliform bacteria, while 36 percent of Pakistanis use water containing E. coli bacteria, which is associated with human and animal faeces.

The 2018 NNS, the largest national survey carried out in Pakistan, was initiated as a joint collaboration between the Ministry of National Health Services, Regulations and Coordination, the Aga Khan University and the United Nations International Children’s Emergency Fund.