Dr Shabana Safdar Khan
Stunting growth of children is a condition where the height-for-age is more than two standard deviations below the WHO Child Growth Standards median. It is caused by poor nutrition, repeated infection, inadequate psychosocial stimulation, and other factors like genetic history and hypothyroidism. It affects the physical and functional development of the child, leading to poor cognition, academic performance, productivity, and health outcomes. It occurs mainly in the first 1000 days from conception until the age of two.
Stunting growth of children is a critical issue in Pakistan, as it has one of the highest prevalence in the world. According to the National Nutrition Survey 2018, more than 40 per cent of children under five years of age in Pakistan suffer from stunting. The situation is especially worse in Sindh, where it has affected approximately 50 per cent of the children3. Stunting has serious implications for the future of the country, as it reduces the human capital, economic productivity, and social development of the population.
There are multiple causes and consequences of stunting in Pakistan, which require a holistic and multisectoral approach to address them. Some of the recommendations are:
Social and cultural: Raise awareness among parents and communities about the importance of optimal nutrition, hygiene, and care practices for children, especially during the first 1000 days of life. Promote exclusive breastfeeding for the first six months and appropriate complementary feeding after that. Encourage early stimulation and learning activities for children. Challenge harmful beliefs and norms that may hinder the adoption of healthy behaviours, such as gender discrimination, early marriage, and superstition.
Political and economic: Increase the allocation and utilization of resources for nutrition-specific and nutrition-sensitive interventions, such as food fortification, micronutrient supplementation, cash transfers, and social protection. Strengthen the coordination and accountability mechanisms among different sectors and stakeholders, such as health, education, agriculture, water, sanitation, and social welfare. Implement policies and regulations that support the promotion and protection of nutrition and health, such as maternity leave, food safety, and breastfeeding codes.
Nutritional and health: Improve the access and quality of health services for pregnant women, lactating mothers, and children, especially in remote and marginalized areas. Provide antenatal and postnatal care, immunization, deworming, growth monitoring, and counselling. Screen and treat children for acute malnutrition, anaemia, and other micronutrient deficiencies. Prevent and manage common childhood illnesses, such as diarrhoea, pneumonia, and malaria.
Water, sanitation, and hygiene (WASH): Ensure the availability and affordability of safe drinking water, improved sanitation facilities, and hygiene products for households and communities. Promote the use of latrines, handwashing, and safe water storage and treatment. Reduce the exposure and transmission of fecal-oral pathogens, which can cause intestinal inflammation and impair nutrient absorption.
The role of the state and society is crucial in the prevention and reduction of stunting in Pakistan. The state has the responsibility to provide an enabling environment and adequate resources for the implementation of effective and sustainable interventions. Society has the power to influence the demand and utilization of these interventions, as well as the social and behavioural change that is needed to improve the nutrition and health status of children. Both the state and society need to work together, with the participation and engagement of all relevant actors, such as civil society organizations, media, academia, private sector, and donors, to achieve the common goal of ending stunting in Pakistan.
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Accordingly, some possible legislative, administrative, execution and charitable recommendations to overcome child stunting growth in Pakistan are:
Legislative: The government should enact and enforce laws that protect and promote the rights of children, especially their right to adequate nutrition, health, education, and protection from violence, abuse, and exploitation. The government should also ratify and implement the Convention on the Rights of the Child and its Optional Protocols and report regularly to the UN Committee on the Rights of the Child on the progress and challenges in fulfilling its obligations.
Administrative: The government should establish and strengthen institutions and mechanisms that coordinate, monitor, and evaluate the implementation of policies and programs related to child nutrition and development. The government should also allocate and utilize sufficient resources and budget for these interventions and ensure transparency and accountability in their delivery. The government should also collect and use disaggregated data and evidence to inform decision-making and planning.
Executional: The government should collaborate and partner with various stakeholders, such as civil society organizations, media, academia, the private sector, and donors, to design and deliver effective and sustainable interventions that address the root causes and consequences of stunting. The government should also ensure the participation and empowerment of children and their families, especially those who are most vulnerable and marginalized, in the process of planning, implementing, and evaluating these interventions.
Charitable: The government should facilitate and support the efforts of charitable organizations and individuals who provide humanitarian and development assistance to children and their families affected by stunting. The government should also encourage and recognize the contributions of volunteers and philanthropists who dedicate their time, skills, and resources to improve the situation of children in Pakistan. The government should also create a conducive environment for social innovation and entrepreneurship that can generate solutions and opportunities for children and their communities.
Therefore, it is critical for the state and society of Pakistan to ensure that the stunting growth of children is reformed for healthy and developed humans. Pakistan can not develop nor grow, with 40 per cent of the children facing acute stunting growth.
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