Government of Pakistan 
                                        
                                        
                                        
                                                
                                        
                                        
                                        
                National Nutrition Survey 2011 
                     Government of Pakistan 
                                        
                                        
                                        
                                                 
                National Nutrition Survey 2011 
                                        
                             Planning Commission                 
                             Planning Commission  
                      Planning and Development Division 
                      Planning and Development Division 
                            Government of Pakistan 
          i                Government of Pakistan 
             |                   National Nutrition Survey 2011        
           
                              
                                                               Government of Pakistan 
                                                                                                                        
                                                                                                                        
                                                                                                                                                  
                                               National Nutrition Survey 2011 
                                                                                                                        
                                                                                        Planning Commission  
                                                                   Planning and Development Division 
                                                                                    Government of Pakistan 
                                                                                                                        
                                                                                                   Conducted by  
                                                                            Aga Khan University, Pakistan 
                                                                                                                        
                                                                                                                        
                                                                                                   Supported by  
                                                                                               UNICEF Pakistan          
                                                                                                                        
                                                                                                                        
                                                                                                                        
                                                                                                                        
                             ii      |                   National Nutrition Survey 2011                                                                                                                                  
                              
                              
                                                                                                                 INDEX 
                             A.  Acronyms------ ------------------------------------------------------------  ------------------------------------------  vi 
                             B.  General definitions  ------------------------------------------------------  ------------------------------------------viii 
                             C.  Reference ranges for biochemical assessments---------------------- --------------------------------------- ix 
                             D.  Executive summary  -----------------------------------------------------  ------------------------------------------  xi 
                             CHAPTER 1: Introduction  ---------------------------------------------------  ------------------------------------------1 
                             1.1          Introduction  ----------------------------------------------------------  ------------------------------------------1 
                             1.2          Context of malnutrition --------------------------------------------  ------------------------------------------1 
                             1.3          Need for a National Nutrition Survey  --------------------------  ------------------------------------------5 
                             1.4          Survey duration  ------------------------------------------------------  ------------------------------------------6 
                             CHAPTER 2: Survey Design and Methods-------------------------------  ------------------------------------------7 
                             2.1          Survey Objectives  ---------------------------------------------------  ------------------------------------------7 
                             2.2          Methodology ----------------------------------------------------------  ------------------------------------------7 
                             2.3          Sample size its allocation  ------------------------------------------  ------------------------------------------7 
                             2.3.1   Sample size estimation for household survey and biochemical assessment  --------------------7 
                             2.3.2   Sampling frame and design  ---------------------------------------  ------------------------------------------9 
                             2.3.3  Sample selection procedure  --------------------------------------  ------------------------------------------10 
                             2.3.4   Target population  ---------------------------------------------------  ------------------------------------------10 
                             2.3.5   Description of questionnaire  -------------------------------------  ------------------------------------------10 
                             2.3.6   Description of qualitative research  -----------------------------  ------------------------------------------11 
                             2.3.7   Biochemical analysis  ------------------------------------------------  ------------------------------------------11 
                             2.3.8   FATA specific data  ---------------------------------------------------  ------------------------------------------11 
                             2.3.9   Project pre implementation steps  ------------------------------  ------------------------------------------12 
                             2.3.10  Plan of operation, training and monitoring  -------------------  ------------------------------------------14 
                             2.3.11  Data management, transfer and analysis  ---------------------  ------------------------------------------14 
                             2.3.12  Ethical approval and confidentiality  ----------------------------  ------------------------------------------15 
                             RESULTS OF THE NATIONAL NUTRITION SURVEY --------------------  ------------------------------------------16 
                             CHAPTER 3: Background and Household Characteristics---------------------- -------------------------------17 
                             3.1          Completion of data collection  ------------------------------------  ------------------------------------------17 
                             3.1.1   Blood and urine specimen -----------------------------------------  ------------------------------------------18 
                             3.2          Background and household characteristics -------------------  ------------------------------------------18 
                             3.3          Formal education – head of household and mothers -------  ------------------------------------------18 
                             3.4          Occupation – head of household --------------------------------------------------------------------- ------18 
                             3.5          Nature of dwelling by type of floor, roof and walls --------------------------------------------- -------19 
                             3.6          Type of cooking fuel   -----------------------------------------------  ------------------------------------------20 
                             CHAPTER 4: Food Insecurity in Pakistan --------------------------------  ------------------------------------------21 
                             4.1          Food secure -----------------------------------------------------------  ------------------------------------------21 
                             4.2          Food insecure without hunger  -----------------------------------  ------------------------------------------21 
                             4.3          Food insecure with hunger (moderate)  ------------------------  ------------------------------------------22 
                             4.4          Food insecure with hunger (severe)  ----------------------------  ------------------------------------------22 
                             CHAPTER 5: Maternal Health and Nutrition ---------------------------  ------------------------------------------23 
                             5.1:         Basic data – age, education and marital status of mothers-------------- ---------------------------23 
                             5.1.1   Age distribution ------------------------------------------------------  ------------------------------------------23 
                             5.1.2   Marital status and current pregnancy status -----------------  ------------------------------------------23 
                             5.2:         Reproductive history and antenatal care ---------------------  ------------------------------------------23 
                             iii     |                   National Nutrition Survey 2011                                                                                                                                  
                              
                     
                    5.2.1   Reproductive history ------------------------------------------------  ------------------------------------------23 
                    5.2.2   Antenatal care --------------------------------------------------------  ------------------------------------------23 
                    5.3:     Knowledge of micronutrients and micronutrient rich foods ---------------------------------------25 
                    5.3.1   Knowledge of micronutrients -------------------------------------  ------------------------------------------25 
                    5.3.2   Knowledge of vitamin rich foods ---------------------------------  ------------------------------------------26 
                    5.3.3   Knowledge about iodized salt and its usage-------------------  ------------------------------------------26 
                    5.4:     Clinical examination  -----------------------------------------------  ------------------------------------------27 
                    5.5:     Anthropometry ------------------------------------------------------  ------------------------------------------28 
                    5.6:     Micronutrient deficiency ------------------------------------------  ------------------------------------------29 
                    5.6.1   Urinary iodine excretion of mother  -----------------------------  ------------------------------------------29 
                    5.6.2   Night blindness  ------------------------------------------------------  ------------------------------------------29 
                    5.7:     Biochemical analysis ------------------------------------------------  ------------------------------------------30 
                    5.7.1   Anaemia (haemoglobin levels)------------------------------------  ------------------------------------------30 
                    5.7.2   Ferritin concentration  ----------------------------------------------  ------------------------------------------31 
                    5.7.3   Vitamin A deficiency  ------------------------------------------------  ------------------------------------------31 
                    5.7.4   Zinc deficiency --------------------------------------------------------  ------------------------------------------32 
                    5.7.5   Vitamin D deficiency ------------------------------------------------  ------------------------------------------33 
                    5.7.6   Calcium Status --------------------------------------------------------  ------------------------------------------34 
                    CHAPTER 6: Child Health and Nutrition  --------------------------------  ------------------------------------------35 
                    6.1:     Nutrition status of children ---------------------------------------  ------------------------------------------35 
                    6.1.1   Children 0–59 months ----------------------------------------------  ------------------------------------------35 
                    6.1.2  Anthropometry (children under 5 years of age) --------------  ------------------------------------------35 
                    6.1.3  Stunting (children under 5 years of age) -----------------------  ------------------------------------------36 
                    6.1.4  Wasting (children under 5 years of age) -----------------------  ------------------------------------------36 
                    6.1.5  Underweight (children under 5 years of age) -----------------  ------------------------------------------36 
                    6.1.6  Education of mothers and its effect on nutritional status of children  ----------------------------37 
                    6.1.7  Malnutrition trends in children under 5 years of age – comparison of SAARC countries -----37 
                    6.2:     Biochemical assessment  ------------------------------------------  ------------------------------------------39 
                    6.2.1  Anaemia ----------------------------------------------------------------  ------------------------------------------39 
                    6.2.2  Iron deficiency (low ferritin levels) ------------------------------  ------------------------------------------40 
                    6.2.3  Vitamin A deficiency in children (under 5 years) -------------  ------------------------------------------40 
                    6.2.4  Zinc deficiency --------------------------------------------------------  ------------------------------------------41 
                    6.2.5  Vitamin D deficiency ------------------------------------------------  ------------------------------------------42 
                    6.2.6  Urinary iodine excretion in children 6–12 years  -------------  ------------------------------------------42 
                    6.2.7   Clinical examination of children under 5 years of age ------  ------------------------------------------43 
                    Section 3: Child morbidity --------------------------------------------------  ------------------------------------------43 
                    6.3.1  Prevalence of acute respiratory infections --------------------  ------------------------------------------44 
                    6.3.2  Prevalence of diarrhoea --------------------------------------------  ------------------------------------------44 
                    CHAPTER 7: Infant and Young Child Feeding Practices -------------  ------------------------------------------45 
                    CHAPTER 8: Food Intake and Practices ----------------------------------  ------------------------------------------50 
                    CHAPTER 9: Elderly Persons Health and Nutritional Status -------  ------------------------------------------54 
                    Chapter 10: National Nutrition Survey – Qualitative Findings----  ------------------------------------------56 
                    Chapter 11: What Next?  ----------------------------------------------------  ------------------------------------------63 
                    Bibliography  -------------------------------------------------------------------  ------------------------------------------65 
                    Annex: NNS Detailed Tables , Sample Design and Sample Weight -----------------------------------------70 
                    iv    |                   National Nutrition Survey 2011