Real lives

Giving Severely Malnourished Children a Chance

© UNICEF/PAKA/2007/Pirozzi

Eighteen year-old Nagina with her seven month-old daughter Sakeeba

By Sandra Bisin

Muzaffarabad, Pakistan-administered Kashmir – Eighteen year-old Nagina is holding her daughter Sakeeba with utmost care. With a weight hardly reaching 2.1 kg when she was admitted for treatment, seven month-old Sakeeba was well below the standards for her age. She should at least be 7 kg.

“As first Sakeeba was unable to breastfeed”, says Nagina. “So I decided to bottle-feed her. But then she started vomiting, her stomach was swollen. I did not know what was wrong with her. I did not know she had diarrhoea. I was scared”.

“Today I understand the reasons why my daughter could not grow”, says Nagina. “I receive advice from the doctor here on how to prepare nutritious food for my child with the resources that are available at home every day. Now I know how to cook porridge for Sakeeba once she gets a little bit older and stronger.”
Nagina asked her uncle to take the baby to a nearby health unit. The child was diagnosed as severely malnourished. “The specialist told my uncle that Sakeeba had to be taken urgently to Muzaffarabad’s hospital where she would get treatment and nutritious food. I understood that her life was at risk”, adds Nagina

Sakeeba was admitted at the UNICEF-supported Therapeutic Feeding Centre in Muzaffarabad, in Pakistan-administered Kashmir. For babies in her condition, a month stay is recommended so that they can gain weight and strength. The centre was opened on 23 February 2006, five months after the devastating earthquake of October 2005, which killed over 73,000 people and affected 3.5 million people in Northern Pakistan. The clinic is the first dedicated centre for severely malnourished children in this region.
 
Although exacerbated by the earthquake, resulting displacements and scarcity of food, malnutrition was already existent before the disaster in northern Pakistan. For UNICEF and its partners, the earthquake provided an opportunity to acknowledge long-existing health issues in these remote, high-altitude regions, and tackle chronic problems like malnutrition for the first time.

At the Therapeutic Feeding Centre in Muzaffarabad, medical staff treat children that suffer from acute malnutrition: they weigh less than 70 per cent of the average weight for their height. UNICEF provides the salaries of the personnel at the centre and supplies food items like fortified and enriched flour (Unimix) and therapeutic milk. More than 180 children have been admitted so far. Most of them come from the nearby districts of Muzaffarabad and Neelum.

“Today I understand the reasons why my daughter could not grow”, says Nagina. “I receive advice from the doctor here on how to prepare nutritious food for my child with the resources that are available at home every day. Now I know how to cook porridge for Sakeeba once she gets a little bit older and stronger.”

© UNICEF/Pakistan/2007/Pirozzi

Nagina feeding Sakeeba with supplementary food

Nagina was only 16 years old when she got married. A few weeks later, the earthquake struck her village, destroying her house and taking the life of her sister. “We are now living in a temporary shelter. My husband is a tailor. He managed to find work after the earthquake, but his earnings are small and it is difficult to make ends meet.”

Nagina is herself anemic: like many women in the region, because of lack of resources, her diet is not balanced. “She uses staple food such as rice or wheat for nearly all her meals, which does not fulfill the iron needs of her body”, explains Riaz Nasrullah, UNICEF Health officer.

“Another problem is that many mothers refuse to breastfeed and bottle feeding is not prepared hygienically”, adds Riaz Nasrullah. “Mothers do not wash hands and the bottle is usually not cleaned properly or boiled. To save money they normally dilute milk with water. This triggers diarrhoea, loose motions as well as loss of weight and appetite for babies.”
 
“This is when the vicious cycle starts: once the child gets sick, his or her immune system is weakened, which means that the child becomes more prone to other diseases and infections, all leading to malnutrition.”

Repeated infections, lack of awareness, insufficient food: these are the contributing factors to malnutrition. Sanitation and water is also a problem. More significant is the lack of education and awareness about nutrition and healthy habits.

With UNICEF support, to date, three Therapeutic Feeding Centres were established at major hospitals in the earthquake-affected areas, resulting in the treatment of almost 300 severely malnourished children. In remote mountainous areas, a community-based therapeutic feeding programme was established, resulting in the treatment of an estimated 400 severely malnourished children.
In addition, UNICEF supported the establishment and functioning of 110 Supplementary Feeding Centres, resulting in the treatment of about 21,000 moderately malnourished children and mothers.

As part of its recovery strategy for quake-affected areas, UNICEF set up a network of community-based outreach workers that are on the frontline of UNICEF’s plans to sensitise communities in rural areas about healthcare and hygiene. Over the past two years, about 2,400 community health workers were recruited and given training by UNICEF and local partners in basic first aid, health monitoring and the provision of essential health services in the home, such as vaccine and basic medicament administration, and newborn care.

“Through these activities, community health workers are becoming agents of change, promoting hygienic practices, breast feeding and healthy food so that in the long run, we keep malnutrition at bay”, says Riz Nasrullah.

For 2008, UNICEF needs more commitments from donors to continue supporting the 2,400 community health workers to reach a total of about 200,000 families with essential health and hygiene messages.