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Pakistan

In Pakistan, countering malnutrition among the most vulnerable

By A. Sami Malik

In a remote district of Pakistan, food scarcity, low rains and lack of access to health services combine with widespread poverty to increase malnutrition and child mortality. UNICEF is helping to respond through community-based measures, better access to services and raising awareness of proper nutrition.  

MITHI, Pakistan, 20 July 2015 – “Raising children has not been easy for me,” says Pushpa, 27. “Each one of my daughters was underweight at the time of birth, and I had to take them to the doctor frequently, as they would often fall sick.”

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© UNICEF/PAKA2015-00290/Zaidi
Pushpa leaves the UNICEF-supported nutrition centre in Meghwar Paro village, in Pakistan's Tharparkar district, carrying therapeutic food for her daughter, Lata, who has been diagnosed as severely malnourished.

She is waiting patiently at a UNICEF-supported nutrition centre for her 7-month-old daughter, Lata, to be examined for her nutritional status. Pushpa is a mother to three young girls and very conscious about their health.

When her two older daughters were growing, they also had the same issues: low birth weight, feeble appearance, lethargic demeanour and frequent infections. She wondered why her children were not healthier.

“I have brought Lata for a check-up because she is weak and cries all the time,” Pushpa says. “I want her to be examined and hope to get those packets [therapeutic food] they give for children. It fills up their stomach and makes them active.”

Pushpa is a resident of Meghwar Paro, a village in Tharparkar district, in the Thar Desert, an area covering more than 120,000 square miles across the Indo-Pakistani subcontinent. Extreme heat in summer, food scarcity, unsafe drinking water and lack of access to basic health facilities have an adverse effect on the life and well-being of communities here. Poverty rates are high, and the lack of rain affects agriculture and livestock, the main sources of livelihood.

As a result, undernutrition is common among children and women. High rates of child mortality – largely due to acute malnutrition – pose a major challenge for local authorities, humanitarian organizations and civil society groups working in the area.

Assessement

At the nutrition centre in Meghwar Paro, the nutrition level of children and pregnant or breastfeeding women is assessed by checking mid-upper arm circumference (MUAC) and by measuring height and weight. Children with severe acute malnutrition (SAM) are admitted to the Outpatient Therapeutic Programme (OTP), while children with moderate acute malnutrition (MAM) are admitted to the Targeted Supplementary Feeding Programme (TSFP).

Micronutrients and medication are provided for acutely malnourished children, and those with complicating illness are referred to the stabilization centre at the District Headquarter Hospital in Mithi, the district capital.

Lata’s height, weight and MUAC reveal that her undernutrition status is severe. She is registered in the OTP, and given sachets of Ready to Use Therapeutic Food (RUTF) – a high-energy peanut paste that contains essential micronutrients to help increase the nutrition level of a child within a short period of time. 

Emergency intervention

For the last several years, UNICEF has been supporting the provincial government to counter acute malnutrition through Community Management of Acute Malnutrition (CMAM) programme. These efforts were intensified in 2014 after a number of child deaths due to malnutrition were reported in Tharparkar district.

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© UNICEF/PAKA2015-00273/Zaidi
Kavita Bai, conducts a session on health education and hygiene for community women in Bhorli Bheel village.

Currently, UNICEF partner organizations Shifa Foundation and the Health and Nutrition Development Society (HANDS) carry out emergency nutrition activities in 44 Union Councils of the district, including screening, treatment, counselling and hospital referrals.

Reaching communities in remote areas is essential for timely detection and for raising awareness about malnutrition. Lady Health Workers and Mothers’ Support Groups both play an important role in identifying malnourished children and women, and referring them to the CMAM centres. They also help young mothers understand infant and young child feeding (IYCF) practices.

Kavita Bai, 25, works as an IYCF Counsellor for the CMAM programme in Tharparkar district. She is the only woman in Meghwar Paro village with a bachelor’s degree and a training certificate in CMAM. Over the last two years, Kavita has worked with four NGOs that focus on malnutrition. She is currently working with Shifa Foundation and conducts sessions on health, nutrition and IYCF.

“Due to lack of education, awareness about health, hygiene, maternal and neonatal issues is generally low among women in this area,” says Ms. Bai. “However, they are keen to learn and adapt health and hygiene practices that I introduce to them during my sessions. More women now prefer delivering through skilled birth attendants or in the Mithi hospital. They breastfeed their children and are conscious about vaccination.”

Recovery

An important aspect of the CMAM process is taking care of children who suffer from severe acute malnutrition and also have medical complications. On average, around 30 to 40 cases are brought to the stabilization centre every month.

“Children who are brought to the stabilization centre, apart from being severely malnourished, suffer from either pneumonia, diarrhoea, fever, or all at the same time,” says Dr. Bhawan Rai, the Medical Officer in charge of the centre.

Treatment includes administering of antibiotics, folic acid, vitamin A and multivitamin supplementation, deworming, iron supply, therapeutic milk and food, Dr. Rai explains.

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© UNICEF/PAKA2015-00278/Zaidi
UNICEF Representative in Pakistan, Angela Kearney visits with child who has recovered from severe acute malnutrition and illness after receiving treatment at District Headquarter Hospital in Mithi.

“Recovery usually begins after the third day, and the child starts gaining weight after seven days,” he says.

UNICEF Pakistan Representative Angela Kearney recently travelled to Tharparkar district to visit the nutrition centres in Meghwar Paro and Bhorli Bheel villages and the stabilization centre in the District Headquarter Hospital in Mithi.

“A lot of good work is in progress, but countering the situation of malnutrition in Tharparkar is a daunting challenge,” Ms. Kearney says. “Some of the communities in Tharparker are the poorest of the poor. With their meagre resources, they can hardly feed themselves and their children.”

Noting that lack of rain has worsened the situation, she emphasizes UNICEF’s continued commitment to improving the nutritional status of children and women of this area.

“Raising awareness regarding health and hygiene and helping communities to access basic health services is imperative, so that precious lives could be saved,” she says. “It is our collective responsibility, and we must not leave the children and women of Tharparkar alone.”


 

 

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