Public health experts have called for comprehensive plans and better coordination among various departments to improve the state of nutrition among children and women in Sindh, after a national nutritional survey report launched on Tuesday showed that food insecurity was the highest in the province. Fight against hunger could be won through long-term plans and interventions targeting women and children with the involvement of the health, education, family planning and women welfare, legal and other social development departments, along with a constant societal advocacy for an increased domestic food production and promotion of the right to food as a human right, said the experts, including representatives of foreign donor agencies. They were speaking at a workshop organized by the Sindh health department’s nutrition cell in collaboration with Unicef, Karachi, to launch the National Nutritional Survey (NNS) 2011 report and prepare an integrated nutrition strategy. Besides Sindh Health Minister Dr Sagheer Ahmad, Secretary Syed Hashim Raza Zaidi and Special Secretary Dr. Suresh Kumar, representatives of the World Health Organization, the World Food Programme, and the United Nations Children’s Fund also spoke to the executive district officers for health who participated in the workshop. Dr. Sajid Soofi of the Aga Khan University, which was awarded the task of the national survey in question, told the participants that about 6,500 households in urban and rural areas across the province were included in the survey. He said the survey showed that about 49.4 percent of the sample households in Sindh used gas as cooking fuel, followed by 48.1pc who used firewood and 2.5pc kerosene oil. At the national level, 58pc households used firewood to cook food, he added. Regarding distribution of households by source of drinking water, it was found that 50.8 percent households used tube-wells, followed by 32pc who had piped water, and 17pc who used other sources such as community taps, wells and bottled water. Discussing formal education, he said the survey highlighted that 64pc mothers were illiterate, while 10.1pc of the sample did complete their school education. About 34.9pc of the urban mothers were illiterate in comparison to 85.4pc mothers in the rural areas, according to the survey. Severe to moderate rate of iron-deficiency anemia in mothers was found between 0.6pc and 20.3pc, while only 16.8pc mothers had the desirable level of Vitamin D in Sindh. Malnutrition in children The survey showed that 17.9pc children in the urban areas and 32.8pc children (both under five) in the rural areas of Sindh were faced with severe stunting. Anaemia level was assessed as severe in 4.9pc and moderate in 67.6pc children. Child retinol was severe in 18.8pc and mild in 34.5pc sample children. Forty-two percent children were found suffering from Vitamin D deficiency, while 38.6pc were found to be zinc deficient. The participants were told that the survey was the largest survey of its nature to date in the country and the first to target provincial level specificity. It confirmed that maternal and child under-nutrition remained a major issue for the province where only 28pc of the households were food secure. The report concluded that anemia and zinc deficiency among women and children were major public health concerns in Pakistan. Food insecurity and poverty were major drivers of under-nutritional childhood, especially stunting, but maternal education appeared to be an important factor in its own right. According to the report, the rate of initiation of breastfeeding and exclusive breastfeeding have increased, but indicators of complementary feeding suggested major deficiency in frequency, food choices and quality of feeding and parallel maximum deficits in growth in infancy. He said that the survey found that indicators for water, sanitation and hygiene remained poor and burden of diarrhea and respiratory infections remained high. These might be additional contributory factors and must be addressed concomitantly, he added. ‘Survey to help focus on needs’ Sindh Health Minister Dr Ahmad, who was the chief guest, said that the national nutrition survey had certainly provided a window to the needs of the province in respect of the food security of the population, especially women and children. “I understand that the participants in the workshop, largely government officers and NGO representatives, have now become aware of the root-cause of malnutrition and they will definitely put their efforts towards preparation and implementation of a well-integrated nutrition strategy in the province,” he said. He said the government realized the seriousness of food insecurity and other lapses that our children had to undergo and finally fall prey to diseases of complicated nature. The minister said that the Sindh health department had a record of coming up to the expectation of the population of Sindh, which was affected due to floods and heavy rains in 2010 and 2011, and again would be able to improve all indicators of the national survey 2011 with the support of Unicef, the WHO and the WFP and other donors. The chief secretary and the chief minister were already on board, he said, adding that other departments would also join in the struggle to improve food and health status of the people, including women and children, of the province. Unicef representative in Sindh Andro Shilakadze said that malnutrition was not only a health subject but was also related to other sectors. He said it needed enhanced efforts by all relevant sectors and authorities to address the issues related to children and women. A good nutrition status acknowledged as to how a country worked and excelled socially and economically, he said. A high prevalence rate of malnutrition among women and children jeopardized not only the health and future of the children but also national security. He said that the issue of anemia in children should be addressed without any delay. Dr Salma Kausar, the head of the Sindh health department nutrition cell, said that a set of recommendations had also been finalized during the workshop. She said various groups had suggested a coordinated structure and institutional set-up, comprising provincial, district nutrition steering committees and technical advisory or task force for responsibilities like advocacy, policy, planning, resources and implementation. Priority action areas as recommended by the officers include direct nutrition interventions, health services, agriculture and food security, water and sanitation, education sector, social sector and food industry. They have also stressed the need for revival of school health programs with a revised plan of action and resources, and facility of micro-credit schemes for women and conditional and unconditional cash grants and training to vulnerable groups.