Protocol: Dietary Intake and Nutritional Status of School-Aged Children in Sindh and Punjab, Pakistan

Abstract

Objectives: Healthy eating habits in childhood promote optimal growth and development. With rapid globalization and urbanization, dietary patterns have been negatively impacted in many countries. For households and ultimately children, there is increased access to unhealthy, nutrient-poor, ultra-processed foods. In Pakistan, there is a persistent high burden of undernutrition and micronutrient deficiencies coupled with rising overweight and obesity. The recent Pakistan Demographic and Health Survey 2017-18 and National Nutrition Survey 2018 has offered insights into the nutritional status of children under-5 years, adolescents and women of reproductive age. However, there is a marked absence of school-aged children (5-9.9 years) within these surveys, and other school-based surveys miss children out-of-school. As such, the objectives of this research are to determine dietary intake, investigate the household and retail food environments and its association with nutritional status. Methods: A multi-stage complex household survey was developed for the provinces of Sindh and Punjab, Pakistan. Both in-school and out-of-school-aged children are eligible to participate. Three core modules will be administered to the total sample of children (n = 3832) (and their caregivers): Module 1: Household, Module 2: Child and Module 3: Child Anthropometric Assessment. Three expanded modules will be administered to a subsample of children (n = 1691): Module 4: 24-hour Dietary Recall, Module 5: Child Biochemical Collection and Module 6: Food Environment. Results: Preliminary results will be available in May 2020. Conclusions: Given our limited knowledge of dietary intake and food environments of school-aged children in Pakistan, this research aims to provide an understanding of both upstream predictors and downstream health outcomes in order to inform policy and develop an evidence-based school health and nutrition intervention planned for 2021.