1. The Importance of Research:
Putting Pakistan on the Nutritional Map
Nilofer Fatimi Safdar, PhD
Director Nutritional Science Program
School of Public Health, DUHS, Pakistan
President, PNDS

2. What is Research?
 Work that adds to scientist's knowledge of how things happen
 Pursuing knowledge through scientific discovery
 Using a scientific method to an investigation / inquiry
 It’s the cornerstone to any health care discipline

3. Advantages of Doing Research
 Enhancement in knowledge, skills,
& competency
 Develops critical thinking
 Improves ability to conduct subsequent well-designed studies
 Support professional growth of members
 Reflects in the standards of professional practice
 Becomes an advocacy of your profession

4. Areas of Nutrition Research Conducted
in Pakistan
 Nutrition Surveys
 Under nutrition among reproductive women & children
 Breast & complementary feeding in children
 Macronutrient deficiencies (PCM)
 Micronutrient deficiencies (Iodine,Vitamin A & iron)
 Risk factors & determinants of malnutrition
 Factors underlying the lack of improvement
in nutrition indicators

5. Nutrition Surveys in Pakistan
 Nutritional Survey ofWest Pakistan, 1965
 Micronutrient Survey Pakistan, 1976-77
 National Nutrition Survey Pakistan, 1985-87
 National Health Survey of Pakistan (NHSP),1990-94
 National Nutrition Survey Pakistan, 2001-2002
 National Nutrition Survey Pakistan, 2011

6. Purpose of Nutrition Surveys in Pakistan
 Estimate the nutrition problem / benchmark for the
future
 Identify population groups at risk
 Assess food security & their impact on nutritional
status
 Identify the need for nutrition interventions
 To help establish or expand existing
surveillance

7. Survey Team Members
 Economist
 Social Scientists
 Research & Survey experts
 Medical doctors/ Physicians
 Pediatrician

8. Results of National Surveys

9. Results of National Surveys
 Malnutrition recognized as a major public health problem
 High numbers to substantiate the extent of malnutrition
 Meetings & workshops are organized to plan strategies for
reducing malnutrition
 Policies and intervention programs are promoted
 Reports are compiled
 Nutrition gets into the agenda of academia /researchers
 Donors gets activated

10. What next?
 Yet malnutrition prevails
 Successive governments have not recognized the importance &
impact of nutrition in the health & development of the people
 None of the surveys have resulted in a national intervention
program aimed at addressing the root causes of malnutrition
 NGOs mostly take over public health nutrition concerns

11. NGOs in Pakistan
 National
 HANDS
 HOPE
 International
 Asia Foundation
 UNICEF
 Micronutrient Initiatives (MI)
 Care
 WHO

12. Key Areas of Nutritional Intervention in
Pakistan
 Child & Maternal under nutrition
 Micronutrient deficiencies
 Breast & complementary feedings
 Infant and young Child feeding programs

13. Nutrition Programs in Pakistan
 Fortification of edible oil with vitamin A & D (1965)
 Supplementary feeding of vulnerable groups (1976)
 Rural Child Survival Project (1987)
 Nutrition Support Program Sind (1989-90)
 Lactation Management Program of baby friendly hospitals (1992)
 Iodine Deficiency Disorder National Program (1994)

14. Nutrition Programs in Pakistan
 School Nutrition Program (1998)
 MassVitamin A supplementation (1999)
 Bait-ul-mal Food Support program (2000/2002)
 National Wheat Fortification with iron & folate (2005)
 Universal salt iodization (2006)
 Lady HealthWorkers to provide nutrition education as part of
family planning program (2010)

15. Outcome of Nutrition Surveys &
Programs in Pakistan
 Minimal public awareness at a national level on the
importance of nutrition in the social and economic
development of the society
 Nutrition remains the key element missing from the
widely discredited Social Action Program
 Few initiatives that addresses food & nutrition research
with qualified people in the public health nutrition issues

16. What could be the Reasons?
 Failure of the Govt, those who undertake surveys, &
those who implement? Collective Failure
 Focus is mainly on assessing indicators
 Less or nil on identifying causal factors
 Lack of qualitative aspect of malnutrition with dietary
factors
 Absence of an expert nutritionist in the survey &
intervention team

17. Tawana Pakistan Project (TPP): 2002-05
 Intersectoral project
 29 districts
 4,000 primary schools
 Focused on girls (5-12 yrs) nutritional status
 Paid attention to fundamental drivers of malnutrition
 Participatory approach
 Field experts
 Culturally appropriate, low cost & local food,
 Nutrition education supplemented the program
 Delivery mechanism to maximize program efficiency
Badruddin SH, et al. (2008). Asia Pac J Clin Nutr 17 Suppl 1, 357-360

18. Tawana Pakistan Project- Results
 Increased ability of women to plan nutritionally
balanced meals from 4.7 % to 34.4%
 Overall malnutrition rate decreased
 wasting by 45%
 underweight by 22%
 stunting by 6%
 Increased school enrollments
 Improved dietary knowledge in the communities

19. Tawana Pakistan Project- Why was it
stopped?
 Intersecterol projects
 Lack of commitment from the Govt
 Prevented siphoning away of funds
 Self interest of higher officials
 Globalization- commodity push

20. Pakistani Journals Publishing Nutrition
Research
 Journal of Pakistan Medical Association
 Journal of College of Physicians and Surgeons Pakistan
 Pakistan Journal of Public Health
 Pakistan Journal of Medical Sciences
 Journal of Ayub Medical College
 Pakistan Journal of Biological Sciences
 Nurture (Home Economics Journal)

21. Published Nutrition Research in
Pakistan (2001-2010)
Year National
Journals
International
journals
nutrition
expert among
the authors
others
(Pediatricians,
Physicians,
economist, health
experts)
2001 4 3 3 4
2002 3 7 3 7
2003 5 6 1 10
2004 5 12 2 15
2005 3 8 none 11
2006 1 4 1 4
2007 5 1 none 6
2008 8 9 4 13
2009 5 9 1 13
2010 9 4 none 13

22. Nutrition Research in Pakistan
(1965-2003)
 Major area-Therapeutic Nutrition
 Search Engine-medline database, pakmedinet & nutrition gate
 Number- 99 research
 Major topics- Diarrhea, diabetes and cancer
 Authors- Pediatrician, Physicians, Food Scientist
 Institutes-AKU, JPMC
 Journal - JPMA.
Tahir,S (2003) M.ScThesis; College of Home Economics, Karachi

23. Who are mostly the stake holders in
nutrition related research?
 Experts in various sciences other than nutrition
 Many of these professionals lack education, training &
expertise in food & nutrition
 Net impact negligible in terms of nutrition awareness or
improvement in nutritional situation in the population
 You are supposedly the spokesperson in promoting the
relationship between good health and diet

24. COBRA –Trial (2004-2007)
 Dietary information using FFQ
 Physical activity assessment using IPQ
 Intervention in the form of Home Health Nutrition Education,
counseling & reinforcement
 Expertise involved for Diet & Nutrition Component of COBRA
study were qualified people in their respective areas
 Papers published to evaluate the efficacy of this program
Jafar TH, et al. (2010) BMJ ; 340, 2641.

25. Dietitians/ Nutritionist Million
Population
0 50 100 150 200 250 300 350 400
Pakistan
Hong Kong
Thailand
Philippines
Malaysia
Indonesia
Singapore
Taiwan
Korea
Japan
Asia
Slide Courtesy: AFDA 2006

26. Where do we mostly work?
Health Care Facility
Community Health
Agency
Institution Foodservice
Establishment
Educational Institutes
Business Company
Consultant,
Private Practice
Others
Slide Courtesy: AFDA 2006

27. Nutrition Research Gaps Among Us
 Lack of leadership role & responsibility in food and nutrition
research
 Hesitant to play a participatory role in nutrition research
 Lack of research ability to conduct well-designed studies
 Lack of research undertaken to address the impact of
nutrition related behaviors, attitudes or cultural practices on
nutritional status
 Unable to disseminate sound scientific information on food
& nutrition to other health professionals

28. Schiller et al. J Am Diet Assoc. 1988;88 (9):1070-1075
Research Activities & Interests of Dietetic
Educators
 Factors that influence research involvement /publications
among dietetics/nutrition professionals
 Postal questionnaire survey in USA
 Factors inhibiting research
 Education
 Lack ofTraining in Research Skills
 Lack of Funds
 Lack of Administrative Support
 Poorly Defined Job Description
 Factors promoting
 Analytical thinking
 Good computer skills
 Degree???

29. Whelan et al. J Acad Nutr Diet. 2012;112:1021-1028
Factors that Influence Research
Involvement among Nutrition Professionals
 Qualitative Study, semi structured interviews with 13
nutrition faculty members in UK universities
 Themes emerged
 Institution/ department (size and structure, research
Philosophy)
 Activities (faculty roles, time, funds, training, teaching)
 The Influence of self / individuals
 Overcoming barriers to research involvement is essential for the
development of the individual, the discipline & the community

30. The Road Forward ……
 Visibility
 Raise your visibility and impact among those who matters
the most
 Identify weaknesses & Competencies
 Commitment to education, learning, training as a
researcher
 Vision
 Multi task & prioritize to handle the task
 Be Assertive
 Learn to handle criticism, but be positive

31. Future Directions
 A national vision needed to guide priorities & to sustain
momentum
 Invest in training of qualified nutrition experts in research &
development
 Boost the morale of nutrition experts & develop research
culture
 Conduct validity studies for diet assessment techniques
 Conduct studies of nutrients & disease outcome
 Qualitative research

32. What PNDS can do to Help you…….
 Spark a stronger research effort
 Organize workshops, seminars, courses & training for
conducting research studies
 Promote research culture through professional advocacy
 Help you translate your work into scientific nutritional
concerns & public health issues in Pakistan
 Expand your role as a researcher in the health-care
environment through the society’s platform
 Generate funds to assist researcher

33. Symposium Outcomes
 Platform to present your research
work
 Opportunity to enhance key
concepts in good quality nutrition
research
 Help seasoned researcher and
nutrition research novice
 Offers opportunities for a fresh
perspective and innovation in food,
nutrition & dietetics

34. ‘Research is at the heart of everything we do.
We need a rigorous knowledge base in order
to make sound clinical decisions and give
credible nutrition advice’.
Dr Susan C. Finn, AND, Foundation Chair for Research Endowment Fund, 2004
‘Nutrition has historically received just a
tiny sliver of the pie when it comes to aid
money. But that is slowly changing’.
Dr Zulfiqar A. Bhutta, Director of Research for Global Child Health, Toronto
Global Health Report, published on 23rd June’, 2013

35. Possess Passion for Your Profession
Never lose your Zest and Curiosity !