The Importance of Research: Putting Pakistan on the Nutritional Map

Transcription

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 of West Pakistan, 1965 Micronutrient Survey Pakistan, National Nutrition Survey Pakistan, National Health Survey of Pakistan (NHSP), National Nutrition Survey Pakistan, 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 ( ) Lactation Management Program of baby friendly hospitals (1992) Iodine Deficiency Disorder National Program (1994)

14 Nutrition Programs in Pakistan School Nutrition Program (1998) Mass Vitamin A supplementation (1999) Bait-ul-mal Food Support program (2000/2002) National Wheat Fortification with iron & folate (2005) Universal salt iodization (2006) Lady Health Workers 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): 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,

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 ( ) Year National Journals International journals nutrition expert among the authors none none none 13 others (Pediatricians, Physicians, economist, health experts)

22 Nutrition Research in Pakistan ( ) 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 ( ) 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 Japan Korea Taiwan Singapore Indonesia Malaysia Philippines Thailand Hong Kong Pakistan Asia Slide Courtesy: AFDA 2006

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

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 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 of Training in Research Skills Lack of Funds Lack of Administrative Support Poorly Defined Job Description Factors promoting Analytical thinking Good computer skills Degree??? Schiller et al. J Am Diet Assoc. 1988;88 (9):

29 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 Whelan et al. J Acad Nutr Diet. 2012;112:

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 23 rd June, 2013

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