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In Pakistan, ECHO Funds Help UNICEF Counter Malnutrition

© UNICEF/Pakistan/2013/Asad Zaidi
Janata bibi, holding her twins, listens attentively to Fazilat Begum, Health and Nutrition Educator during a session on Infant and Young Child Feeding at the BHU Urmar Miana.

By, A. Sami Malik Khyber Pakhtunkhwa province, Pakistan: Holding her seven-month-old twins close to her chest, Janata bibi (27) listens attentively to the benefits of breast-feeding and nutritious diet for children. Along with other women of her community, she had come to attend a session on health and nutrition being conducted by the Health and Nutrition Educator, Fazilat Begum at the Basic Health Unit (BHU) Urmar Miana, in Peshawar district of Khyber Pakhtunkhwa province.

 

In Pakistan, ECHO Funds Help UNICEF Counter Malnutrition

Janata bibi has four children. Her youngest born are twins. Akif is a boy and Laila, a girl. Apart from struggling with her own health since the delivery of the twins, Janata had been particularly worried about Akif's health as he would remain unwell most of the time and appeared weaker compared to his twin sister.

One day, a woman came to Janata’s house and said that she was a Community Outreach Worker from the BHU, Urmar Miana. She assessed the nutrition level of both her children by using the Mid-Upper Arm Circumference (MUAC) method and told Janata bibi that her boy was suffering from acute malnutrition. She advised her to bring the twins along with her two older children to the BHU so that they could be further checked and treated for malnutrition.

Next morning, Janata bibi took her children to the BHU Urmer Miana. After a thorough examination, she was told that three of her children were moderately malnourished while Akif, one of the twins, was suffering from severe acute malnutrition.

The Nutrition Assistant at the BHU, provided Janata bibi Ready to Use Supplementary Food (RUSF) for her moderately malnourished children and Ready to Use Therapeutic Food (RUTF) for Akif along with systematic anti-biotic medication to treat the severity of his acute malnutrition. Since Janata’ is lactating and also suffering from moderate malnutrition, she also received fortified blended food for herself. Within few days, not only Akif’s health improved but she herself started feeling better. 

"My children are much better with this treatment. I advise all women whose children are weak to bring them here. I was not hopeful that my children will survive. But they are much better and I am very hopeful now. I attend the sessions and have learnt many good things about keeping my children healthy."  Janta Bibi

"My children are much better with this treatment,” says Janata bibi. “I advise all women whose children are weak to bring them here. I was not hopeful that my children will survive. But they are much better and I am very hopeful now. I attend the sessions and have learnt many good things about keeping my children healthy." 

UNICEF started the Community Management of Acute Malnutrition (CMAM) programme in Khyber Pakhtunkhwa and Sindh provinces of Pakistan in 2009. The programme includes door to door visits by Community Outreach Workers to screen children and pregnant and lactating women for malnutrition, conducting sessions on health and hygiene in communities and at the Basic Health Units,  treating the severely and moderately malnourished cases and referring cases with medical complications to stabilization centres in the tertiary care hospitals.
 
Raising awareness in communities
Communities in Khyber Pakhtunkhwa are conservative and for any behavioural change activity, it helps if the community worker is a local resident. Fazilat Begum belongs to Urmar Miana and is working as a Health and Nutrition Educator in the CMAM programme. She has twelve years of experience in conducting sessions on health, hygiene and Infant and Young Child Feeding (IYCF). Every week, Fazilat conducts two sessions in the BHU Urmar Miana and one session in the community. One of the community members has voluntarily provided her house for the sessions.

“I inform them about nutrition and what it means,” says Fazilat Begum, Health and Nutrition Educator. “I tell them which of their children is malnourished and needs treatment. I also tell them about the importance of breastfeeding. I insist that for the first six months the child should only be breastfed and thereafter supplementary feeding should start.”

© UNICEF/Pakistan/2013/Asad Zaidi
Fazilat Begum, Health and Nutrition Educator, is conducting a session on IYCF at the house of a community member in Urmar Miana, Peshawar district, Kyber Pakhtunkhwa.

CMAM programme in Nowshera district
In the neighbouring Nowshera district, the CMAM programme is benefitting a large number of children and women belonging to families which have been displaced from the Federally Administered Tribal Areas due to insecurity. These Internally Displaced Persons (IDPs) are residing with their extended relatives or in rented abodes.

Gull Sana (26) is a Community Outreach Worker engaged with the UNICEF supported CMAM programme in Nowshera district. She visits IDP families as well as host communities to screen young children and pregnant and lactating women who suffer from malnutrition.  She advises women to attend sessions conducted within their communities or at the nearest BHU and have their children and themselves treated for malnutrition.  

As Gull Sana visits one of the displaced families living in Yaqoob Garhi, a small locality in Nowshera district, she is greeted with a smile by women in the house. This is the family of Gulbaz Khan who belongs to Kurram Agency and has been living in here for the last fifteen months along with his parents, wife and five children. Gull Sana explains to the women that she has come to tell them about maintaining good health and hygiene in the family and also to check the nutrition status of their children. She conducts MUAC test on children and advises their mother on cooking nutritious food for them. 

"UNICEF is running 72 CMAM sites in Khyber Pakhtunkhwa and out of which forty two sites are supported by ECHO funds, Community Outreach Workers visit houses to screen women and children. Those malnourished are referred to the CMAM sites and admitted to the Outpatient Therapeutic Programme (OTP) or Supplementary Feeding Programme (SFP) according to their nutritional status. Children, who are malnourished and have medical complications, are referred to stabilization centres established in tertiary care hospital's paediatric unit.” Ambreen Qazi.

When Gull Sana identifies malnourished children and women in the community, she invites them to the BHU Daag Behsud which provides basic health services to people living in neighbouring villages. At the BHU, nutrition level of women and children is reassessed and those suffering from  acute malnutrition are admitted for treatment.

In Khyber Pakhtunkhwa, so far, nearly 180,000 children have been screened for malnutrition. Around 5,000 were identified as severely malnourished and about 19,000 as moderately malnourished. Around 70,000 pregnant and lactating women were also screened for malnutrition and more than 11,000 were admitted to Supplementary Feeding Programme.  In addition, hundreds of thousands of children and women have been educated on health, hygiene and nutrition practices.

A generous donation of € 4.5 million (Euro) from the European Commission's Humanitarian Aid department (ECHO) has helped UNICEF to continue with the CMAM programme for the benefit of the internally displaced population residing in Khyber Pakhtunkhwa as well as communities which are hosting them.

"UNICEF is running 72 CMAM sites in Khyber Pakhtunkhwa and out of which forty two sites are supported by ECHO funds," says Ambreen Qazi, UNICEF Nutrition  Officer. “Community Outreach Workers visit house to house to screen women and children. Those malnourished are referred to the CMAM sites. They are further assessed at CMAM sites and admitted to the Outpatient Therapeutic Programme (OTP) or Supplementary Feeding Programme (SFP) according to their nutritional status. Children, who are malnourished and have medical complications, are referred to stabilization centres established in tertiary care hospital's paediatric unit.”

Stabilization centres at tertiary care hospitals  
When the CMAM programme staff identifies children suffering from malnutrition with medical complications, they refer them to the nearest stabilization centre by the CMAM programme staff. These centres have been established in tertiary care hospitals.

A stabilization centre established in the children’s ward of the Lady Reading Hospital, Peshawar can accommodate up to 18 children at a time. With support from UNICEF, this centre provided services to more than 1300 children during 2012. Here, children receive round the clock attention and the medical staff treats them for malnutrition as well as hypothermia, hypoglycaemia, severe anaemia or any other medical complication that they may have. 

 

 

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