Fifty percent of children under five years of age in Sindh province are stunted
Pakistan has made no progress on reducing Stunting – WB report
By Nasir Aijaz
Stunting, a condition characterized by impaired growth and development in children, is a major public health issue in the province of Sindh, Pakistan. According to recent data, the prevalence of stunting in Sindh is alarmingly high, with nearly half of all children under the age of five being affected.
Fifty percent of children under five years of age in Sindh province are stunted, which has both adverse physical and cognitive development effects and are a result of chronic or recurrent malnutrition.
“Forty-one percent of children under five years of age in Sindh province are underweight,” according the data collected by Sindh Bureau of Statistics.
Several factors contribute to the high prevalence of stunting in Sindh. Poor nutrition, inadequate access to clean water and sanitation, and limited healthcare services all play a role in the development of stunting in children. Additionally, poverty, lack of education, and cultural practices such as early marriage and gender discrimination further exacerbate the problem.
The consequences of stunting are severe and long-lasting. Children who are stunted are more likely to suffer from chronic illnesses, cognitive impairments, and reduced productivity later in life. This not only affects the individual child but also has broader implications for the economic and social development of the region.
Efforts to address the issue of stunting in Sindh must be comprehensive and multi-faceted. This includes improving access to nutritious food, promoting breastfeeding and proper infant feeding practices, enhancing water and sanitation infrastructure, and increasing access to healthcare services. Education and awareness campaigns are also crucial in changing cultural norms and practices that contribute to stunting.
The government of Sindh, along with non-governmental organizations and other stakeholders, must work together to prioritize and invest in interventions that address the root causes of stunting. By taking a holistic approach to tackling this issue, we can ensure that all children in Sindh have the opportunity to grow and develop to their full potential.
Graveness of Stunting Issue
The graveness of the stunting can be judged from the fact that a World Bank delegation raised the issue in a recent meeting with Sindh Chief Minister Syed Murad Ali Shah, who admitted that the critical environmental drivers of stunting including water, sanitation, hygiene, and the agri-food system exist in the province.
The World Bank Country Director Mr. Najy Benhassine, along with his delegation held the meeting to discuss the Child Stunting in Sindh.
According to Murad Shah, the overall stunting rate in Sindh as assessed by UNICEF in its survey of 2014 was 48 per cent. The Sindh government had launched the WB-assisted Multi-Sectorial Accelerated Action Plan (AAP) in 2017 to reduce stunting from 48 per cent to 30 per cent by 2021 and then further reduction up to 15 per cent by 2026.
During the meeting Chief Minister claimed that the stunting rate has started coming down from 48 per cent but its assessment could be made through another survey, which has not yet been started. He had nothing to say except making a stereotype statement that ‘the local government and Public Health Engineering departments were working to ensure the treatment of drinking water, sewage and effluent, while for the mass rollout of a behavioral change, PPHI and the health department were working.’
He also made a lofty claim that the declaration of Open Defecation Free (ODF) Villages was being made through water sources testing for biological and chemical contaminants, and demos on the construction of household latrines were made in the villages, and behavior change communication campaigns were in progress. ‘My government was working to promote Community Led Total Sanitation (CLTS),” Murad Shah further claimed.
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Murad Shah told the WB delegation that his government has also decided to increase the operation and maintenance budget of water and sanitation schemes so that out-of-order schemes could be made functional, including RO plants. It is pertinent to note that over fifty percent of the total RO Plants in Sindh are nonfunctional due to lack of funds and malpractices rampant in concerned departments and agencies.
Chief Minister made another hollow claim that the Asset Distribution was started by providing livestock – five Goats and 10 poultry to each beneficiary household. Provision of veterinary services in terms of vaccination and drenching twice a year (2 doses) was also carried out and launched awareness regarding nutrition and livestock-improved management practices.
Pakistan makes no progress on reducing Stunting
Meanwhile, a WB presentation says that Pakistan has made no progress on reducing Stunting. “This is despite two decades of significant progress in reducing extreme poverty from 64% in 2001 to 22% in 2018,” the report released in May 2024 under the title ‘CAN PAKISTAN GROW WITH A 40% CHILD STUNTING RATE?’ says.
According to the report, 80 percent of brain development occurs in the first two years of life, hence gestation to age 2 is the critical window for addressing stunting that leads to heightened childhood morbidity and mortality, and lifelong chronic health conditions and reduced physical capacity.
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The WB report pointed out that the 2022 floods and the prevailing high rate of inflation have likely further worsened stunting rates over the past two years. The floods had caused reduced labor productivity and income besides lower educational attainment.
The WB report also warned of rise in chronic non-communicable diseases (like diabetes and cardiovascular disease) due to stunting while communicable diseases remain endemic, and reduced capacity of population to cope with climate extremes-especially heat stress.
“A stunted mother is more likely to give birth to an infant who is already stunted at birth – locking the economy into a long-term low growth trajectory,” it said.
Access to Toilets
Only 22% of households have access to toilets connected to underground sewer systems. These are mostly upper income and urban. Conditions for poor urban dwellers are similar to rural households, WB report notes.
Both urban sewer systems and rural toilets leach untreated wastewater into surface and groundwater systems contaminating waterways, surface and ground water sources and exposing communities to fecal waste close to homes.
Between 30% and 50% of water tested at source (tap, mechanized, and hand pumps) indicates bacterial contamination. The water quality is not much better in urban centers, including major metropolitan centers like Karachi and Lahore.
WB further states that the dietary quality and diversity is among the lowest in the world- and is now also at risk from environmental degradation and climate change.
Also read: Sindh –A Province in Turmoil
The WB underlined the need to integrating the nutrition interventions into primary health care to ensure adequate preventive and curative health care for mothers and young children; provision of safely managed water and sanitation and safe management of animal and solid waste. Suggesting the improved access to a diverse and nutritious diet, the WB called for sustainable and regenerative agriculture, and poultry and livestock rearing, to improve food security for pregnant and lactating women and young children; promotion of kitchen gardens.
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Nasir Aijaz is a senior journalist based in Karachi, the capital of Sindh province of Pakistan. He is author of nine books and hundreds of articles on language, literature, history, and other topics. He can be reached at nasir.akhund1954@gmail.com
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