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Seeking out hidden hunger

Malnutrition caused by micronutrient deficiencies threatens the lives and life chances of children and adults across the globe. We are tackling this form of hunger in Pakistan by improving access to nutritious food for more than half its population.

The effects of poor nutrition on health

Razia Bibi fears for her two-year-old daughter, Atiqua. The toddler has a poor appetite and does not play as much as the other children in her family’s home village. Atiqua is less active because she is malnourished, a victim of ‘hidden hunger’.

Lack of vitamins and minerals such as vitamin A, iodine and iron is the main cause of ‘hidden hunger’, so named because it tends not to show any outward symptoms.

This form of malnutrition affects more than 2bn people worldwide. Pakistan is one of the countries worst affected.

The last national nutrition survey revealed that 50% of women of reproductive age were anaemic. In children under five, 44% had stunted growth and 32% were underweight.

New hope for the malnourished

Now there is hope for children like Atiqua. UK aid is funding the Food Fortification Programme (FFP) as part of its five year Supporting Nutrition in Pakistan scheme, which will complement the Government of Pakistan’s own efforts to combat malnutrition.

The FFP initiative will be jointly implemented and run by Mott MacDonald, which has managed large-scale health improvement programmes in Pakistan for more than 10 years, and Nutrition International (NI), a Canadian not-for profit organisation which has run a wide range of nutrition and fortification projects in Pakistan for a similar length of time.

Food fortification involves adding micronutrients to foods that are widely consumed. The aim of FFP is to enhance the lives of millions of vulnerable women and children by improving their access to sufficient nutritious and safely fortified wheat flour and edible oil.

Nearly half of the programme’s £46M budget will go towards equipment for wheat and oil millers and subsidies on premix they can add to their products.

Food fortification for the masses

In Pakistan, the Universal Salt Iodisation programme, supported by NI, helped to increase the number of Pakistani households consuming iodised salt from 17% to 60% since 2006, contributing to a reduction in iodine deficiency disorders such as mental impairment in newborns, goiter (swelling of the thyroid gland) and stillbirth.

FFP is on a much bigger scale. The ambition is to get 57% of Pakistan’s 190M population consuming fortified flour and 72% of the population consuming fortified oil (or ghee).

When combined with nutritional education, improved food safety and micronutrient supplementation, food fortification can yield sustained improvements in nutritional health. It is estimated FFP could contribute to a one third reduction in iron deficiency anaemia among children under five and women of reproductive age, a 50% reduction in neural tube defects in newborns and a one third reduction in vitamin A deficiency.

Effective enforcement of standards

We are engaging with key Pakistani public and private sector players, such as district, provincial and national governments.

Our remit includes providing support to strengthen fortification standards, mandatory legislation and regulatory frameworks, and making certain there is effective government enforcement against businesses not adequately fortifying food or guilty of supplying adulterated or counterfeit goods.

The backing of the food industry is equally important and we will be working closely with industry associations, mill owners and managers to obtain buy-in and build capacity. For food fortification to work, it is necessary to ensure that the food, once fortified, retains its original properties – in particular its appearance and taste – in order to be easily accepted by people.

Advertising and marketing campaigns will be needed to persuade consumers to pay a little extra for genuine products and not buy cheaper products that may be adulterated or fake.

Food fortification is a very cost-effective public health intervention. According to the Copenhagen Consensus, a team of Nobel laureate economists, for every US$1 spent on reducing chronic undernutrition, there is a US$30 return on investment through greater productivity and reduced healthcare expenditure. The team also found that micronutrient interventions – fortification and supplementation with vitamins and minerals – were the most cost-effective investment.

The international nutrition community agrees, and the FFP initiative was designed with this in mind. The road ahead appears promising and challenging. Nevertheless, a first step has been made towards ending hidden hunger in Pakistan – and ensuring that its most vulnerable people can look forward to a brighter and healthier future.

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