In Pakistan, we love food but we don’t really care about the nutritional value of what we’re eating. Nutrition knowledge is very poor in the country. This is true for not just the general public, but for clinical practitioners too.
“Nutrition is not a priority for Pakistanis,” says Lieutenant Commander Rabia Anwer, the vice-president of the Pakistan Nutrition and Dietetic Society (PNDS).
Almost 37% households in Pakistan are “food insecure”, which means they don’t have access to the right type and amount of food due to limited resources. This is why malnutrition is prevalent.
Clinical malnutrition can lead to high-dependency clinical care, lengthen recovery times and increase the likelihood of complications, according to a new report by Abbott and the Economist Intelligence Unit.
Malnutrition affects almost 50% of patients admitted to hospitals worldwide; yet only seven percent are typically diagnosed.
Lack of trained nutritionists and dietitians
Healthcare set-ups here don’t focus on nutrition specialists.
Due to the lack of trained nutritionists and dietitians in Pakistan, “most patients are not screened for malnutrition upon admission into hospital,” says Anwer.
More than two thirds of those with malnutrition deteriorate further during their stay.
“If afflicted patients were identified early on and provided with a suitable diet by a trained dietitian mortality and cost of care would all be reduced.” she says.
Staff is also limited.
“It is not humanly possible for me to do a malnutrition assessment of every patient,” she laments.
Often the terms nutritionist and dietitian are used interchangeably. The PNDS requires a dietitian to have dietetics qualifications and training, whereas a nutritionist does not.
As a result, all dietitians are nutritionists, but not all nutritionists are dietitians.
Patients don’t like the food at hospitals
The cheapest way to improve nutritional care is to get patients to eat more of the food that is given to them.
A recent survey in Pakistani hospitals, however, concluded that patients were generally unhappy with the quality of hospital food and not inclined to eat it, according to the new report.
One solution could be to allow patients to give feedback on their meals. But public sector hospitals are very crowded.
“When a hospital is heavily crowded you cannot, for example, calculate each and every individual’s foodstuffs or the nutrition they need,” said Dr Baseer Khan Achakzai, the director of the Ministry of National Health Services nutrition programme.
Expensive food supplements
Oral nutritional supplements are another way to reduce the length of hospital stays and costs.
But the cost and affordability of such supplements are issues for patients who use public sector services, Anwar says.
“For a middle income person, it is very difficult to purchase these nutritional supplements for their diet.”
Patients who cannot afford the supplements do not follow the prescribed care plan, leaving them at a higher risk of readmission.
Clinical staff have no nutrition knowledge
A lack of nutritional knowledge among clinical staff in Pakistan is a persistent issue.
“[Hospitals] are not very receptive towards a dietitian,” Anwar says. “Those practitioners who are locally educated in Pakistan, they don’t support [dietitians].”
They want to prescribe their own diet and they tell the dietitian to only make the menu for it, she said.
“If people who are not qualified and trained [lead the education], the public cannot understand the problem,” says Professor Dr Rubina Hakeem, who is the principal and professor of nutrition at Rana Laiquat Ali Khan College of Home Economics.
Limited policies
The nutrition policy landscape is fragmented. There is little monitoring and evaluation of whether strategies are effective.
“There is no regulatory body who can regulate the practice of dietitians,” Anwar points out.
It was because of this failure to regulate that she and several colleagues formed the Pakistan Nutrition and Dietetics Society in 2003.
Pakistan’s healthcare system, however, is not solely governed by the centre. Reforming the health system can be a lengthy bureaucratic process.
“Hospitals come under the provincial government domain, so in Pakistan the healthcare services are decentralized to the provinces and we cannot interfere in what policies they have, what SOPs they adopt,” Dr Achkazai says.
Dr Hakeem said: There is no national level guideline about clinical nutrition because not even all the hospitals are bound to have a dietitian or nutritionist.
The future of clinical nutrition in Pakistan
There is a need to update and revise the national nutrition strategy.
“Nutrition is at the base of good health”, said Professor Dr Javed Akram, the vice-chancellor of Lahore’s University of Health Sciences.
“Getting the important nutrients through adequate nutrition is instrumental for people to grow and stay healthy at all stages of life.”
Among solutions that can remedy malnutrition and improve outcomes are medically tailored meals, meal replacements and nutritional supplements, he said.
