Assessment of health and nutrition status among children aged 5–9 years in Pakistan: a cross-sectional survey (2020)

Background Childhood nutrition influences long-term health and nutrition, but the data on children aged 5–9 years is scarce. In this population-level study from Pakistan, we evaluated the nutritional status and associated factors among children aged 5–9 years to inform potential policy and program planning. Methods This cross-sectional survey was conducted in two of the largest provinces in Pakistan using a stratified cluster sampling at the household level. Data were collected from 5952 children aged 5–9 years on socio-demographic indicators, anthropometric measurements, hemoglobin levels, food security and dietary diversity. Descriptive analyses and multivariable logistic regression models were performed in STATA to examine associations between nutritional outcomes and selected covariates. Findings A concurrent burden of undernutrition and overweight was observed among children 5–9 years, with marked geographic variation. Overall, 17.6% of children were underweight, 7.4% were overweight, 23.4% were stunted, and 35.4% were anemic. Children in Punjab had significantly lower odds of underweight (AOR: 0.73, 95% CI 0.61–0.87), stunting (AOR: 0.62, 95% CI 0.54–0.73), and anemia (AOR: 0.45, 95% CI 0.39–0.53) compared to Sindh. Urban residence showed a marginal association with higher odds of obesity (AOR: 1.02), while belonging to the richest wealth quintile was strongly associated with increased odds of obesity (AOR: 2.59) compared with rural residence and the poorest quintile, respectively. Gender differences were evident, with boys having significantly higher odds of obesity (AOR: 1.40). Interpretation The co-existence of undernutrition and overweight highlights a growing double burden of malnutrition among children in Pakistan. Inequities in nutritional outcomes were driven by socio-economic status, gender identity and geographic location. The study highlights the urgent need for targeted interventions aimed at both the direct and underlying determinants. Funding Funding for this survey was made available through the SCANS consortium.