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Tackling Malnutrition with Supplementary Feeding Centres

© UNICEF/PAKA0023/Bisin
The Lady Health Visition checking Usman's height in the Attarshesha Supplementary Feeding Centre

By Sandra Bisin

Mansehra, North West Frontier Province, 4 May 2007 – At Attarshesha’s brand-new Supplementary Feeding Centre, Salma, 22 years old, checks Usman’s weight and height. The four-year-old boy stares at the Lady Health Visitor, his eyes wide open. He looks intimidated and does not risk a move as the young woman briskly takes him from the scales to the measuring board, and back onto his mother’s lap. Usman weighs 11 kg, and he is 93 centimetres high.

“Your son is malnourished”, Salma tells his mother Yasmeen. “For the same height, his weight should be 13.5 kg”. The lady health visitor hands Usman’s mother a plastic container filled with Unimix, a nutritious fortified flour.

“Your son is malnourished”, Salma tells his mother Yasmeen. “For the same height, his weight should be 13.5 kg”. The Lady Health Visitor hands Usman’s mother a plastic container filled with Unimix, a nutritious fortified flour.
 
“Use one cup of Unimix, add three cups of water, then mix with two tablespoons of oil and cook for ten minutes. You can prepare other dishes such as paratha (local bread), halwa (local desert), porridge and cookies by mixing Unimix with ingredients like oil, water, flour and sugar”, advises Salma. “Usman should have it four to five times a day, in addition to regular meals.”

“This will help to improve his weight and reduce the deficiency in vitamins and minerals”, she smiles.

The clinic is one of the 50 Nutrition Surveillance-Supplementary Feeding Centres supported by UNICEF and its partners in rural areas as part of its two-year recovery plan, following the 8 October 2005 earthquake that claimed the lives of over 73,000 people. The clinic treats mildly and moderately malnourished children who weigh between 70 and 80 per cent of the average weight for their height.

Moderately malnourished children from 6 months to 5 years, as well as pregnant and lactating mothers are provided with 3.5 kg of Unimix for a period of four months. Severe cases are referred to the Therapeutic Feeding Centre which is a forty minutes drive away from Attarshesha and treats acute and chronic malnutrition. 

At the centre, services provided to patients are free. UNICEF pays the salary of the Lady Health Visitor and provides food supplements, drugs and medical equipment. About 375 children have been screened at Attarshesha Supplementary Feeding Centre since the clinic was set up in February 2007. The team of doctors and Lady Health Visitors has registered 64 moderately malnourished children and four pregnant and lactating women for provision of Unimix. 

“Malnutrition was an issue in the district even before the earthquake, as 34 per cent of children were underweight”, explains Dr Bilal Ahmed, UNICEF Nutrition officer in Abbotabad. “A health and nutrition survey conducted right after the earthquake revealed that 38 per cent of children were malnourished as the situation had further deteriorated and communities had even less access to food, water and basic sanitation facilities”.

A woman and her daughter enter the consultation room and Salma’s face stiffens. She checks the 5 year old girl’s upper arm circumference, as well as her height and weight. Shanza weighs 12.2 kg for 107 centimetres, which is less than 70 per cent of the average weight for her height.

© UNICEF/PAKA004/Bisin
The Supplementary Feeding Centre at Attarshesha

“Your daughter suffers from severe malnutrition”, Salma tells the mother. “Her life is in danger and requires urgent medical attention. You will have to visit a Therapeutic Feeding Centre as soon as possible. If you face any problem, let us know. We will do our best to support you”. Since Attarshesha’s Supplementary Feeding Centre opened, this is the third case of severe malnutrition the clinic’s team has come across.

While rocking her daughter’s frail body, Shanza’s 30-year-old mother, Flaynisa, gives a bleak insight into her life. “We walked 30 minutes to come to the centre because I don’t even have 30 rupees (US $0.5) to pay for the bus.”

“There are many factors leading to malnutrition”, says Dr. Atta Ur-Rehman, Field Medical Coordinator for the Nutrition programme run by Relief International, an implementing partner for UNICEF. “Poor diet, scarcity of food, low literacy levels and lack of sensitization to nutrition issues are just a few of them. Also, parents often show preference for their sons rather than their daughters when it comes to food as well as access to health services.”

“We have no sustainable means of income: my husband is a labourer at construction sites”, Flaynisa adds. “Sometimes he finds work, sometimes he doesn’t… I have seven children and it is very difficult to meet the needs of everyone when we do not have a regular income. We eat three times a day though: rice, wheat, maize and potatoes, but no meat. It is too expensive and not available at our local market”.

“There are many factors leading to malnutrition”, says Dr. Atta Ur-Rehman, Field Medical Coordinator for the Nutrition programme run by Relief International, an implementing partner for UNICEF. “Poor diet, scarcity of food, low literacy levels and lack of sensitization to nutrition issues are just a few of them. Also, parents often show preference for their sons rather than their daughters when it comes to food as well as access to health services.”

To tackle the long-standing problem, UNICEF and its partners are conducting awareness sessions on nutrition at community level, involving religious leaders, mothers and nazims (local political leaders).

UNICEF is also establishing a network of 4,000 community-based health workers whose key priority is to sensitize communities on basic health and hygiene practices as well as to detect cases of malnutrition and refer them to the Supplementary Feeding Centres. Community Health Workers were also trained on breastfeeding promotion, as many mothers, traumatized by the disaster, stopped lactating after the earthquake.

“I feel grateful I have been told early enough that my daughter needs special care. I felt so helpless when I came to the centre. Now I know we are in good hands and I will do my best to give Shanza what she needs”, says Flaynisa.   

 

 

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