The alarming prevalence of vitamin and mineral deficiencies in children across the country is undermining Pakistan’s ability to achieve its development potential, said speakers at Aga Khan University’s Conference on Nutrition and Early Human Development. Vitamins and minerals, or micronutrients, are vital components of good nutrition and health which promote physical and intellectual development in many important ways. A lack of iron, vitamin A or vitamin D is often referred to as ‘hidden hunger’ as symptoms are not visible as in other forms of malnutrition such as wasting and being underweight. But a lack of these essential micronutrients can lead to serious, lifelong repercussions, including delayed growth, reduced immunity to disease, frequent fatigue and poor school achievement. Over six out of 10 children (62.7 percent) across the country are vitamin D deficient, while more than half of under 5s (53.7 percent) suffer from anaemia or a lack of vitamin A (51.5 percent), according to the 2018 National Nutrition Survey (NNS). These nutrition deficits are present across all socio-economic strata and are noticeable in the country’s most affluent areas. “Poverty isn’t the sole cause of Pakistan’s malnutrition challenge as you can see vitamin and essential mineral deficits in the wealthiest households,” said Prof Zulfiqar A Bhutta, founding director of Aga Khan University’s Centre of Excellence in Women and Child Health. “Our nutrition challenges aren’t just the responsibility of the ministry of health. Malnutrition affects indicators in education, gender equity, as well as our ability to address social inequalities. That’s why we need solutions that cut across sectors such as agriculture, education and clean water and sanitation, which actively involve parents and communities.” The 2018 NNS shows that the country faces a triple burden of malnutrition with micronutrient deficiencies, under-nutrition and obesity coexisting in Pakistan’s population. In his presentation, Prof Bhutta noted that Pakistan has had long-running programmes to fortify cooking oil, ghee and wheat with vitamins. Despite these programmes, levels of vitamin A and vitamin D deficits and severe iodine deficiency have risen since the last survey in 2011. The NNS shows that only one in seven children between 6-23 months of age receive meals with minimum dietary diversity that includes four food groups. Furthermore, fewer than one in 20 children (3.6 percent) were being fed complementary foods that would ensure optimal growth. Experts noted that the country lacks a complementary food strategy and called on the government to form a multi-sector working group to lead efforts in this area. Speakers noted that lady health workers could be asked to emphasise the importance of key minerals in child growth but also called for nutrition awareness sessions targeting primary school children. Health awareness programmes must continue to reinforce the importance of breastfeeding. According to the 2018 NNS, one in five children across the country are not breastfed and only 56 percent are breastfed until the World Health Organisation- recommended two years of age. Speakers at the three-day conference noted the importance of nutrition and health in early child development in enabling a child to achieve their physical, emotional and cognitive potential. They added that pursuing an integrated approach to ECD has a multiplier effect that can help achieve targets under 7 Sustainable Development Goals such as No Poverty, Zero Hunger, Good Health and Wellbeing, Quality Education, Gender Equality, Clean Water and Sanitation, and Reduced Inequalities. The three-day conference in Karachi was attended by over 200 academics, policymakers, experts and ECD professionals from 26 countries around the world.