By: A. Sami Malik
Umerkot, Sindh: It was only two months ago that nine-month old Nindoo was diagnosed to be suffering from severe acute malnutrition. Frequent diarrhoea and gradual loss of weight gave his mother, Chothi Usman, sleepless nights.
“He would get frequent diarrhoea and cried all the time”, says Chothi. “I didn’t know what to do. One of the women in our neighbourhood told baji (sister) Koshlia about my child. She came to my house and checked Nindoo. She told me that he was severely malnourished and needs proper treatment”.
UNICEF leads Community Management of Acute Malnutrition
Chothi (26) is a resident of Ganga Bheel village in Umerkot district. Historically known as the birth place of the great Mughal emperor Akbar, Umerkot is located in Pakistan’s southern province of Sindh. Being part of the Cholistan dessert, this area is hard to access and among the poorest in the country.
“He would get frequent diarrhoea and cried all the time”, says Chothi. “I didn’t know what to do.Koshlia Rathore (22) is the Health and Nutrition Educator at the Nutrition Centre in Akhiji Dhani village of Umerkot district. This is one of the 27 centres operating in the district as part of the Community Management of Acute Malnutrition (CMAM) project which is being funded by the European Commission’s Humanitarian Aid department (ECHO) and implemented by the United Nations Children’s Fund (UNICEF). Koshlia visits neighbouring villages and communities to raise awareness about health and hygiene issues by conducting sessions, as well as to identify children and women suffering from malnutrition.
Two months after being admitted to the Outpatient Therapeutic Programme at the Centre for Community Management of Acute Malnutrition in Akhiji Dhani village, Umerkot district, a MUAC test on the nine-month old Nindoo reveals his nutrition level to have improved from SAM to MAM.
The Shifa Foundation, a Non-Governmental Organisation (NGO) and UNICEF’s partner, has established all 27 Nutrition Centres in Umerkot district. Services provided at these centres include sessions on health, hygiene and Infant and Young Child Feeding (IYCF), screening and treatment for children and pregnant and lactating women, as well as provision of Ready to Use Therapeutic Food (RUTF) and Ready to Use Supplementary Food (RUSF).
At the Centre in Akhiji Dhani village, the nutrition level of children and pregnant and lactating women of the village and nearby communities is assessed through Mid-upper Arm Circumference (MUAC) and measurements of their height and weight. Children with Severe Acute Malnutrition (SAM) are admitted to the Outpatient Therapeutic Programme (OTP) and children with Moderate Acute Malnutrition (MAM) are admitted to the Supplementary Feeding Programme (SFP). In case of children who, apart from being acutely malnourished, also have a mild medical condition, medication is provided at the Centre. However, in cases where children suffer from severe medical complications, the cases are referred to the nutrition stabilization centres in the tertiary care hospitals.
When Koshlia identified Nindoo to be severely malnourished, she advised Chothi to have him admitted in the OTP. Within a few weeks, Nindoo’s malnutrition level improved. Chothi still brings him to the Centre for follow-up checks and to collect RUSF. Nindoo is now a healthier and a happier child, and Chothi is certain that he will soon regain optimum nutrition level.
Raising awareness is key to preventing malnutrition
In rural Sindh, awareness regarding health, hygiene and feeding infant and young children is quite low. The CMAM programme is therefore not only about curing children suffering from malnutrition but also about prevention of malnutrition by raising awareness. Sessions on health, hygiene and IYCF practices conducted by the Health and Nutrition Educators both in communities and CMAM Centres are key to reducing the high rates of malnutrition in the region.
“In Sindh province we already have a very high GAM (Global Acute Malnutrition) rate of 17.5 per cent, which means we are in an emergency situation," says Dr. Mazhar Alam, UNICEF Nutrition Officer.Community outreach is essential for timely detection and spreading awareness about malnutrition: Lady Health Workers and Mothers Support Groups play an important role in identifying malnourished children and women and referring them to the CMAM centres. These groups also help young mothers to understand IYCF practices.
“According to the WHO guidelines, if the rate of malnutrition is above 15 per cent, then it is an emergency,” says Dr. Muhammad Mazhar Alam, UNICEF Nutrition Officer. “In Sindh province we already have a very high GAM (Global Acute Malnutrition) rate of 17.5 per cent, which means we are in an emergency situation”.
Malnutrition makes children susceptible to medical complications
Children who are severely malnourished become susceptible to other medical complications. When such a child is brought to any of the centres for CMAM in Umerkot district, he or she is referred to the Nutrition Stabilization Centre established at the District Headquarter Hospital. Here, the child is kept under constant observation and treated for malnutrition as well as his or her medical condition.
Dr. Kanaya Lal, paediatrician at the DHQ Umerkot, examines a child who has been referred to the Nutrition Stabilization Centre due to medical complications, as well as being severely malnourished.
“We try our utmost to provide needed supplements to the patients (children) and remove their medical complication,” says Dr. Kanaya Lal, Paediatrician at the hospital, Umerkot. “The major cause for malnutrition is that mothers do not breastfeed their children. Secondly, they do not space their pregnancies enough. Thirdly, children are not given a weaning diet when they are six months of age which is crucial for a child to gain weight. When the child loses weight, medical complications such as diarrhoea, pneumonia and measles could occur”.
ECHO’s support to CMAM Programme in Pakistan
In South Asia, one out of every three children is acutely malnourished. Malnutrition is one of the leading causes of death amongst children below the age of five.
“We recognise these challenges as being of emergency humanitarian concern,” says Olivier Delclos, from the ECHO Pakistan office.ECHO has been supporting UNICEF to counter malnutrition in Pakistan since 2011. Till date, more than 560,000 children, mothers, pregnant women and health care providers have benefitted from this programme in Khyber Pakhtunkhwa and Sindh provinces of Pakistan.
“We recognise these challenges as being of emergency humanitarian concern,” says Olivier Delclos, from the ECHO Pakistan office. “However, providing treatment only solves part of the problem, as unless we simultaneously address the root causes of these high rates of malnutrition, we will be fighting a losing battle. Through our partners, we therefore advocate for a holistic approach which encompasses both treatment of severe cases as well as the provision of multi-sectorial aid in the fields of water and sanitation, hygiene, access to health, food security and livelihoods support, all of which contribute to making people less vulnerable to malnutrition”.