sohail j. malik - food consumption patterns and nutrition

Food Consumption Patterns and Nutrition

Sohail J. Malik

Hina Nazli

Asma Shahzad

Amina Mehmood

April 15, 2015

Plan of Presentation

• Food security and Consumption Patterns

• Food prices and cost of calories

• Nutritional status and hidden hunger • women

• children

• Determinants of malnutrition in Children

• Policy implications and Recommendation

Food Security and Resilience

Foo

d S

ecu

rity

Availability

Production + Stocks

Income

Imports-exports

Accessibility Prices

Poverty

Income

Utilization

Consumption

Water, sanitation and Hygiene (WASH)

Nutritional status

Nutritional status

Sustainability Variability in availability, accessibility, utilization Resilience

Per capita availability (kg/annum) declining or stagnant

0

20

40

60

80

100

120

140

160

2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12

Per capita availability (kg/annum) of Wheat and Milk

Wheat Milk

0

5

10

15

20

25

2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12

Per capita availability (kg/annum) of Other Food Items

Rice Pulses Edible oil/ghee Meat

Source: GoP (2013). Agriculture Statistics of Pakistan 2011-12

Average Supply of Calories per adult equivalent per day has increased over time and is higher than the recommended allowance of 2350

Source: GOP (2014), Economic Survey 2013-14

0

500

1000

1500

2000

2500

3000

2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11

Cal

ori

es/a

du

lt e

qu

ival

ent/

day

2350

Food Accessibility in Pakistan

Decreasing ability to access: Kilograms of Wheat Flour that one Day’s Wages can Buy declining

0

5

10

15

20

25

30

35

2006 2007 2008 2009 2010 2011 2012

Kilo

gram

s o

f Fl

ou

r p

er d

aily

wag

e (K

gs)

Skilled Isamabad

Skilled Karachi

Skilled Lahore

Unskilled Islamabad

Unskilled Karachi

Unskilled Lahore


Calorie consumption is lower than calorie supply

0

500

1000

1500

2000

2500

3000

2001-02 2004-05 2005-06 2007-08 2010-11

Cal

ori

es p

er c

apit

a p

er d

ay

Available Consumed

Government of Pakistan (2011). Change in the cost of Food Basket 2010-11. Nutrition Cell, Planning Commission

On Average more than 70% of food expenditure is spent on Dairy, Wheat, Fats, Sugars, and Meats (2010-11)

Source: HIES 2010-11

0

5

10

15

20

25

30

Dairy Wheat Oils Sugars Meats Pulses Fruits & vegs Other

SHA

RE

OF

FOO

D E

XP

END

ITU

RE

(%)

Overall Non-poor Poor

Differences in the Consumption Patterns of Agricultural and Non-agricultural households (Rural Pakistan 2010-11)


0

2

4

6

8

10

12

Milk Wheat Fruits &vegetables

Sugar Rice Fats Meat Pulses

kg/c

apit

a/m

on

th

Agricultural households Non-agricultural households

Share of Food expenditure of Poor Households is High and Food Expenditures are Rising

0

10

20

30

40

50

60

70

2001-02 2004-05 2005-06 2007-08 2010-11

% h

ou

seh

old

s

Botton quintile Highest quintile

Source: HIES (various issues)

Poor Spend more on wheat and non-poor on Dairy (2010-11)

0

5

10

15

20

25

30

Dairy Wheat Oils Sugars Meats

SHA

RE

OF

FOO

D E

XP

END

ITU

RE

(%)

Pakistan

Non-poor Poor

0

5

10

15

20

25

30


SHA

RE

OF

FOO

D E

XP

END

ITU

RE

(%)

Urban areas

Non-poor Poor

0

5

10

15

20

25

30


SHA

RE

OF

FOO

D E

XP

END

ITU

RE

(%)

Rural areas

Non-poor Poor


Limited Dietary Diversity in Rural Pakistan: (% households reporting type of food items consumed in last 24 hours – PSSP 2014)

Source: RHPS (2014)

0 1 2 3 4 5 6 7

Wheat flour

Spices, condiments

Ghee/butter/oil

Sugar

Dairy products

Tomato, onion, egg plant etc.

Roots and tubers (potatoes, turnip)

Pulses

Vitamin A-rich vegetables

Rice

Vitamin A-rich fruits

Eggs

Poultry

Dark green leafy vegetables

Fresh meat

Other fruits

Other cereals

% households

Wheat is the major source of energy

0

10

20

30

40

50

60

Wheat Oils Dairy Sugars Meats

% S

HA

RE

IN T

OTA

L C

ALO

RIE

S

Overall Non-Poor Poor


Trends in the Prices of Food Items

0

20

40

60

80

100

120

140

Wheat flour Basmati rice Moong Sugar Milk

Rs/

kg

2000-01 2004-05 2009-10 2013-14


Sharp Increase in the Price of Wheat since 2007-08

0

5

10

15

20

25

30

35

2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11

Rs/

KG


Calories consumed and the cost of calories (2010-11)


0.0

1.0

2.0

3.0

4.0

5.0

6.0

100 Calories cost Overall Food excluding wheat (Rs) 100 Calories cost Wheat (Rs)

Rs/

10

0 c

alo

ries

Rural Poor Rural Non-Poor Urban Poor Urban Non-Poor

Econometric Estimates indicate that Increase in Wheat Price has possible adverse implications for other essential Human Development Indicators

• An increase in the price of wheat may not result in substitution with other food items (low own and cross price elasticity)

substitution with non-food items is possible

• A substitution with health and education may worsen the already low human development indicators

adverse effect on already high levels of poverty in the country

• Serious implications especially for current nutritional status and productivity of future generation

• A further reduction in the purchasing power of the wage earners can aggravate this situation further

Source: Authors estimates using HIES 2010-11 data and applying LA-AIDS model

Dietary patterns impact on nutritional status

Malnutrition among Women (BMI) – Over 47 % are Malnourished 2010-2011

0

10

20

30

40

50

60

Underweight (<18.5) Normal (18.5-24.9) Overweight (25-29.9) Obese (>29.9)

% W

OM

EN (

15

-49

YEA

RS)

Pakistan Urban Rural

Source: NNS 2010-11

Hidden Hunger: Micronutrient Deficiency among Women (2001-2011)

0

10

20

30

40

50

60

Prevalence of Anemia Vitamin A Deficiency Zinc Deficiency%

WO

MEN

(1

5-4

9 Y

EAR

S)

Pakistan

2001 2011

0

10

20

30

40

50

60

Prevalence of Anemia Vitamin A Deficiency Zinc Deficiency

% W

OM

EN (

15

-49

YEA

RS)

Urban areas

2001 2011

0

10

20

30

40

50

60


WO

MEN

(1

5-4

9 Y

EAR

S)

Rural areas 2001 2011

Source: NNS (2001; 2010-11)

Undernourished Females – Implications for Future Generation

• A malnourished woman is at higher risk of giving birth to an anemic or an underweight child (less than 2.5 kg) • such children have five times the risk of death in the first year and

• high risk of growth failure during childhood

• Low birth weight may result in greater chronic diseases as an adult

• Severe iron deficiency anemia causes deaths during pregnancy and childbirth

• Iodine deficiency in pregnancy causes the birth of mentally impaired children

• Human and economic potential can be at risk due to malnutrition

Source: World Bank (2006)

Pakistan: Child malnutrition Results in • Child mortality

• Low birth-weight babies (31.6% of live births in 2007) rank 3rd highest in 183 countries

• Under five mortality rate (86 per 1000 live births, 2008-2012) ranks 26 out of 194 countries

• Infant mortality rate (74 per 1000 live births, 2008-2012) • Neonatal mortality rate (55 per 1000 live births, 2008-2012)

• Disability • About 2.65 % population was disabled in 2012 (based on the projections on 1998

Census), 2.54% was in 1998 • Of these, 43% are children (1-15 years) • Of total disabled, 8.2% are blind, 7.5% deaf, 14% mentally retarded, 8.3% have

multiple disabilities

• Probability of falling sick, loss in work days and income

Source: PDHS 2012-13 Source: UNICEF, State of the World's Children, Childinfo, and Demographic and Health Surveys by ICF International Source: Helping Hands for Relief and Development (2012). Persons with Disabilities (PWDs) Statistics in Pakistan 2012

Malnutrition (PEM) among Children 2010-11 (under 5 years of age)

0

10

20

30

40

50

60

70

1977 1985-87 1990 1990-94 2001 2011

% c

hild

ren

Underweight Stunted Wasted

Source: NNS 2010-11

How reliable are the data? Variations in the estimated malnutrition indicators based on different national surveys for the same year 2001

0

10

20

30

40

50

60

70

Underweight Stunted Wasted

% c

hild

ren

National Nutrition Survey 2001 Pakistan Socio-Economic Survey 2001 Pakistan Rural Household Survey 2001

Hidden Hunger: Micronutrient Deficiency among Children (2001-2011)

0

10

20

30

40

50

60

70


CH

ILD

REN

Pakistan

2001 2011

0

10

20

30

40

50

60

70

Prevalence of Anemia Vitamin A Deficiency Zinc Deficiency

% C

HIL

DR

EN

Urban areas

2001 2011

0

10

20

30

40

50

60

70


CH

ILD

REN

Rural areas

2001 2011

Source: NNS (2001; 2010-11)

Low Levels of Mothers’ Knowledge about Child Nutrition

23.59 25.59

14.06

0

5

10

15

20

25

30

Iron deficiency Iodine Rich Food Drinking Water Treatment

Pe

rce

nta

ge

Source: RHPS (2012)

High and Variable Prevalence of Malnutrition (<–2SD) by Province and Rural Pakistan (2013)

40

46

23

35

41

22

52

59

28 31

38

16

0

10

20

30

40

50

60

70

Underweight Stunting Wasting

% C

HIL

DR

EN

All Pakistan Punjab Sindh KPK

Source: Authors’ estimates using RHPS, Round 2 (2013)

Determinants of Malnutrition: Results of Logistic Regression

• Mother’s education improves the general state of nutrition among children under five

• Improving hygienic conditions appear important to reduce long term malnutrition (toilet facility and safe drinking water)

• Access to health care services plays a significant role in reducing the short-term nutrition (LHW)

• Incidence of malnutrition among children under five is highest in Sindh

• The prevalence of malnutrition is high across all income groups

• Poverty and malnutrition are determined by the same variables

• Nutritional status is a more direct measure of household welfare

Source: Authors’ estimates using RHPS, Round 2 (2013)

Summing up

• High prevalence of malnutrition in the country: • Poverty - Lack of resources at the household level to maintain the minimum daily

allowance of essential nutrients;

• limited diversification because cost of non wheat calories significantly higher

• Lack of awareness about balanced diet and maintaining good health

• Focus of previous research on estimating numbers only

• Food Security not fully understood or integrated into policies • Little work on understanding the linkages between food security, consumption

behavior and nutritional outcomes and variations across socio-economic groups and regions

• Need re-prioritization and evaluation of any previous policies and programs

Summing up • The consumption of micronutrient rich foods is very low (vegetables and

fruits)

• Average calorie consumption is lower than the recommended level of

2350 and unbalanced in terms of micro-nutrients

• Wheat is the main source of calories, carbohydrate and fiber

• Food policy to date focused on availability of wheat tonnage through

production and import. Little diversification away from four major crops.

• Lesser focus on accessibility, sustainability and safety.

• Wheat consumption is price inelastic (implications for dietary diversity and

household expenditures on education, health care, etc.)

Results Indicate the Need for:

• Massive nutrition awareness campaigns and education

• Provision of safe drinking water

• Improvement in sanitation facilities

• Expansion in health care coverage (e.g., lady health workers)

• Promotion of kitchen gardens

• Food fortification and bio-fortification

• Special attention to the mother’s nutritional status through proper medical care, adequate food, and iron, folic acid, and multivitamin supplementation

Recent Global Initiatives to address Malnutrition

• Global Alliance for Improved Nutrition (GAIN) (2002)

• United Nation’s Millennium Development Goals • First goal “eradicate extreme poverty and hunger.” Undernourishment and malnutrition are

amongst the indicators for this goal

• United Nation’s Sustainable Development Goals (2012) • Replacement of MDGs

• United Nation’s zero hunger challenge (2012) • Elimination of stunting is the first goal

• United Nation’s Scaling up nutrition (SUN) movement (2009)

• The First 1000 Days Initiative

• The Copenhagen Consensus 2012

Recent Nutrition Initiatives in Pakistan

• National Zero Hunger Program, launched in 2012

• Pakistan’s draft Agriculture and Food Security Policy 2013 aims to address

the food and nutrition insecurities

• Pakistan Integrated Nutrition Strategy (PINS), launched in 2013, aims to

address the underlying causes of malnutrition (food diversification, WASH,

school feeding, etc.)

• Scaling Up Nutrition (SUN) program, launched in 2013, aims to identify the

hurdles in access to food and address the issue of malnutrition

Needed Steps

• Improve identification of malnourished population based on scientific method

• Sustained political commitment and government ownership

• Institutional and sectoral coordination and collaboration

• Sufficient resource allocation to strengthen implementation • Massive awareness campaigns • Enhancing zero hunger program, PINS, SUN • Ensuring synergies - no overlaps

• Monitoring and evaluation system to improve real-time program implementation and effectiveness

Thank you so much

sohail j. malik - food consumption patterns and nutrition

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