Evaluation of Nutrition Surveys in Flood-affected Areas of Pakistan: Seeing the Unseen!

Abstract

In 2010 Pakistan experienced the worst floods recorded in its history; millions of people were affected and thousands lost their lives. Nutrition assessment surveys led by UNICEF were conducted in flood‐affected areas of Punjab and Sindh provinces to assess the nutrition status of children between 6–59 months while Aga Khan University (AKU) undertook a parallel assessment including micronutrient status in their project areas within Balochistan, Sindh and Punjab. Standardised Monitoring and Assessment of Relief and Transition (SMART) methodology was used. 881 children from Sindh, 1,143 from Punjab and 817 from AKU project areas were measured for anthropometry and their households were interviewed. The findings indicated that while immediate life‐saving interventions were essential, there was also an urgent need to address chronic malnutrition. Through high‐level dissemination of the survey results, treatment and prevention of malnutrition has become a priority for the provincial and federal government in Pakistan and for donors.

Geographical and socioeconomic inequalities in women and children's nutritional status in Pakistan in 2011: an analysis of data from a nationally representative survey

“…Our analysis shows major geographical and socioeconomic differentials in maternal and childhood undernutrition, beyond what could be the consequence of localised acute events such as floods. 38 We noted large spatial variations in children's and women's nutritional status, with about 30 districts having prevalences of children's stunting and underweight well above the highest reported at the national level among developing countries 5 and ten districts having a prevalence of underweight children as low as the best low-middle-income country. 7 The most affected districts are in the south of the country and within the provinces of Baluchistan, Khyber Pakhtunkhwa, and Sindh, largely matching the known poverty patterns and district-specific multidimensional poverty indices.…”

“…Although there is some recognition that national data can mask wide disparities, subprovincial differentials in nutrition have only recently risen to the fore after recent emergencies especially the floods of 2010 and 2011 and resultant population displacement. There is a misperception that these malnourished populations are exceptional, resulting from extreme events such as floods, earthquakes, and drought, 38,44 which is especially underscored by the recent focus on child mortality in the drought-affected district of Tharparkar. 45,46 Our findings suggest that such differentials in nutrition status among districts and subpopulations in Pakistan are widespread, and probably longstanding as suggested by data for height and stunting (both long-term outcomes).…”

A systematic review and meta-analysis assessing the impact of droughts, flooding, and climate variability on malnutrition

“…Six studies were considered 'Good,' 14 were considered 'Fair,' and 2 were given a rating of 'Poor.' Of those that received a 'Fair' or 'Poor' rating, 5 were confounded by food aid (Arlappa et al, 2009;De Waal et al, 2006;Kumar & Bhawani, 2005;Renzaho, 2015;Renzaho, 2007), 2 relied on control data that was over 10 years old (Singh et al, 2006;Singh et al, 2008), 3 lacked a comparison group (Hossain et al, 2013;Renzaho, 2007;Salama et al, 2001), and 2 failed to provide sufficient time between the climate exposure and malnutrition outcome (De Waal et al, 2006;Rodriguez-Llanes et al, 2011). Figure 2 displays the characteristics and main findings of the final 22 studies.…”

Multisector governance for nutrition and early childhood development: overlapping agendas and differing progress in Pakistan

“…The widespread floods of 2010 and 2011 further served to highlight malnutrition in flood affectees to the general public—hence nutrition suddenly became visible. 44 This was closely followed by the launch of the National Nutrition Survey (2011) providing dismal country and provincial statistics. These events were well advocated by development partners to the media, politicians and senior bureaucracy, using local experts and paediatricians as powerful advocates.…”