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Attacking chronic malnutrition in the poorest rural areas of Nepal

By Guy Hubbard

KHATI GAUN and BIRALTOLI, Federal Democratic Republic of Nepal, 9 January 2013 - Deep in the foothills of the Himalayan mountains, Pashupati Saud is up early, harvesting herbs and vegetables from her small garden. She cooks them into a sauce and gives them to her 8-year-old son, along with a bowl of rice soaked in buffalo milk.

UNICEF correspondent Guy Hubbard reports on a UNICEF-EU-Government programme that is battling malnutrition in Nepal.  Watch in RealPlayer


It’s a breakfast rich in vitamins and protein, perfect for a young child. But it is unusual in rural Nepal, where most people survive on staple grains alone. Ms. Saud is a volunteer community health worker and has been taught the value of adding vitamin- and protein-rich ingredients to her family’s diet.

She is part of a country-wide programme backed by UNICEF and the European Union aimed at ending chronic malnutrition in Nepal.

Battling food insecurity

Mountainous Nepal, one of the poorest countries in South Asia, is notoriously food insecure. Its topography is partly to blame. The mountains isolate many of the poorest people, who struggle to feed themselves and to ensure that they have clean water, adequate sanitation and healthcare.

While there is agriculture in the mountains, it is seasonal. Stockpiles barely last through the winter months. Mountain agriculture is also labour intensive, and parents often spend full days working the fields while young children, alone at home, go hungry.

Half of the country’s children are stunted, and 1 in 10 are wasted.

© UNICEF video
In rural Nepal, many people survive on staple grains alone. The country is one of the poorest in South Asia. Half of the country's children are stunted.

Raising awareness and monitoring children

Every month, Ms. Saud and another volunteer organize a basic clinic for mothers and children in their village, Khati Gaun, in the rural Southwest. The clinic is their opportunity to change the behaviour, diets and nutrition of the families in their village. They pass on to other mothers what they’ve learned about what and how to feed their families and about hygiene, and they screen every child for malnutrition. Severely malnourished children are referred to the hospital.

Despite regular counselling, there are always mothers who don’t, or can’t, afford to feed their children properly, so there are always cases of malnutrition. Two-year-old Asmita Badi has been referred to the local health centre for further treatment. Asmita’s mother was not aware of Asmita’s condition, and she is grateful to the volunteers for diagnosing and helping her daughter.

Reaching the poorest

Another obstacle in the fight against malnutrition is the caste system, which, while officially abolished, can remain deeply entrenched in rural areas. Victims of caste-based discrimination are mostly landless and are significantly poorer than other Nepalese people.

In Biraltoli, in the West, community health volunteer Laxmi Bhul goes door to door screening children for malnutrition. The high levels of poverty here mean that all children, especially those with a history of malnutrition, are vulnerable.

© UNICEF video
Community health worker Pashupati Saud, shown here preparing a nutritious meal for her family, teaches families in her rural area about nutrition and hygiene and screens children for malnutrition.

“My baby was very sick and suffering,” explains one mother. Through Ms. Bhul’s efforts, the boy, 3-year-old Rosan, is now plump, healthy and energetic.

However, many of the families here can’t afford to follow Ms. Bhul’s advice on diet and feeding patterns, and many children become malnourished again and again. She continues to diagnose and treat them, again and again.

Managing nutrition at the community level

Ms. Bhul feels the health and nutrition of every child in Biraltoli is her responsibility. “I do this job because this village is my family and my life,” she says. “At first, there were lots of children and even mothers suffering from malnutrition in this village, but through my work, I’ve been able to help them. I’ve been able to help the village, and I’m very grateful for that.”

Volunteer-based community management of malnutrition is one small part of the broader partnership of UNICEF, the European Union and the Government, aimed at ending chronic malnutrition, but it’s the most important part. The dedication and commitment of the volunteers are the cornerstones of the project. With so many communities so poor, so isolated and so often uninformed, volunteers such as Ms. Saud and Ms. Bhul are the first line of defence against malnutrition.



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