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Fighting Malnutrition in Pakistan with a Helping Hand from Children Abroad

By A. Sami Malik
Nearly half of all children in Pakistan are chronically malnourished (stunted) while 11 per cent are acutely malnourished (wasted). This situation contributes to high mortality and morbidity rates among children under 5 years of age, undermining their mental and physical growth and leading to significant economic impact on the country’s development and prosperity.

In the province of Punjab, while stunting is declining, wasting is increasing in more than two-thirds of the districts at an alarming rate. This is a serious threat, and stunting could begin to increase in future. UNICEF is helping Pakistan to overcome this persistent problem by identifying malnourished children and women, especially in hard-to-reach, marginalized communities, and raising their nutrition levels through systematic interventions.
Muzaffargarh, Punjab - July 2016: It was only seven weeks ago that a worried mother walked into the Basic Health Unit Mehmood Kot, carrying a feeble-looking child in her arms. This was Haseena Fiyyaz (35) with her ten-month-old boy, Younas. One could easily notice that not only the child, the mother too was frail and underweight.

“Baji, my boy has become weak, cries a lot and is lazy all the time,” says Haseena explaining her child’s condition to the Lady Health Visitor, Sumaira Yasmeen. “I breastfeed him and also give him buffalo milk but he keeps getting diarrhoea and is losing weight day by day.”"Mother’s milk is the best food for a child. However, some mothers start giving additional diet in the form of powder milk. This is given to the child through a bottle," says Abida Nasreen, the Assistant District Coordinator, IRMNCH&N

Once Sumaira had performed the Mid Upper Arm Circumference (MUAC) check on Younas and measured his weight and length, it became evident that he was suffering from Severe Acute Malnutrition (SAM). She registered Younas in the Outpatient Therapeutic Programme (OTP) which is part of the Community Management of Acute Malnutrition (CMAM) programme. 

Sumaira handed Ready-to-Use Therapeutic Food (RUTF) sachets to Haseena and explained that Younas should be given these every day. She also advised her to attend the health, hygiene and nutrition sessions that are conducted in the BHU and also in the community to help women understand the significance of breastfeeding, maintaining better hygiene and a nutritious diet. Haseena left with a two week supply of RUTF and collected more as she needed.    

© UNICEF/Pakistan2016/Asad Zaidi & Sami Malik
Only seven weeks after registering in the UNICEF-supported Outpatient Therapeutic
Programme, the nutritional status of ten-month-old Younas has improved from
severe to moderate acute malnutrition.   
Seven weeks later, after doing a follow-up check on Younas, Sumaira is delighted to see that his MUAC measurement has improved from 10.5 to 11.5 centimetres and the weight has increased from 5.7 to 6.6 kg. Overall, his nutritional status had improved from SAM to Moderately Acute Malnutrition (MAM).

“Every month, 20 to 25 new children are registered in the OTP,” says Sumaira. “This is a small BHU and that many new cases of malnutrition every week is not a good sign. We are however trying to help mothers and children by giving them Multi-vitamins and minerals supplementation and nutrition advice for taking appropriate & adequate home based food. If a child is severely acute malnourished, we give him Ready to Use Therapeutic Food (RUTF), which is internationally used as treatment for such children.”

© UNICEF/Pakistan/AsadZaidi
Being diagnosed with Severely Acute Malnutrition, Younas was registered in the
Outpatient Therapeutic Programme at BHU Mehmood Kot and provided adequate amount
of Ready-to-Use Therapeutic Food to raise the level of nutrition in his body in
a short period of time. 
Malnutrition is a major issue for women and children, especially in rural areas of Pakistan. It has a direct relation with Infant & young child feeding and hygiene practices. If a pregnant woman is malnourished, the child is likely to be born underweight which makes him susceptible to infections, hence the risk of becoming malnourished and eventual death. Exclusive breastfeeding for the first six months is vital to prevent malnutrition amongst new born. If possible, it should continue till the child is two years of age. However, Pakistan has the worst breastfeeding indicators in South Asia and Punjab has the worst breastfeeding indicators in Pakistan.
In 18 out of the 36 districts of Punjab, over 4,000 severely acute malnourished children are registered in the OTP every month. Food insecurity, maternal under nutrition, disease and illness, inadequate health services and lack of awareness about feeding and healthcare practices are the main reasons for malnutrition in children. UNICEF is helping the provincial health department to counter the situation by sensitising women about their personal hygiene and that of their children. Health, hygiene and nutrition sessions are conducted within the communities and also at the BHUs. Importance of handwashing with soap, exclusive breastfeeding for first six months and a nutritious diet is emphasised during these sessions.

“If a mother is breastfeeding, her own nutritional status has a direct bearing on that of the child,” says Abida Nasreen, the Assistant District Coordinator, IRMNCH&N. “Mother’s milk is the best food for a child. However, some mothers start giving additional diet in the form of powder milk. This is given to the child through a bottle. A bottle and the nipple which is not properly disinfected could cause diarrhoea which can be very harmful especially for a child who is already undernourished. It is therefore important that mothers are taught proper breastfeeding techniques and are sensitized about hygiene measures that can prevent their children from falling ill. We do this during the health, hygiene and nutrition sessions and during the Infant Young Child Feeding Counselling (IYCF) sessions.”

© UNICEF/Pakistan/AsadZaidi
A Lady Health Worker is conducting a health, hygiene and nutrition session for
women and children in Mehmood Kot. These sessions are conducted in the community
and also in the BHU to sensitise women about their personal hygiene and that of
their children.
The Department of Health, Government of Punjab has launched an Integrated Reproductive Maternal Neonatal Child Health and Nutrition (IRMNCH&N) Programme. The Nutrition component of the programme is supported by UNICEF. It includes screening of children and “Considering the encouraging results of the Nutrition Programme, the Government of Punjab has scaled up Nutrition Programme in 22 district which is more than half of the province,” says Uzma Khurram, Nutrition Officer, UNICEF Lahore Field Officepregnant and breast-feeding mothers to check their nutritional status; provision of micronutrient supplements; conducting awareness sessions on health, hygiene and nutrition; counselling mothers about breast-feeding practices; treatment of Acute Malnutrition. 

For the overall effectiveness of the Nutrition programme and in particular the OTP, adequate and regular supply of RUTF & micronutrients is essential. UNICEF procures a major part of the RUTF for the Government of Pakistan which is used in various provinces. 

The UK Kidpower is a non-profit organisation in the United Kingdom which encourages increased activity in children while sensitizing them to problems of malnutrition in other parts of the world. For every activity that children carry out, they receive points which can be used to procure RUTF. The UK Kidpower has donated £30,000 to UNICEF Pakistan Country Office for purchase of RUTF to be distributed amongst children suffering from malnutrition in South Punjab.   

RUTF procured through the UK Kidpower donation is being utilised in five Union Councils (administrative area) of Muzaffargarh district where the nutritional status of children is particularly low. Nearly 700 children in these Union Councils were identified as SAM cases. These children have been registered in the OTP and are receiving adequate supply of RUTF to improve their nutritional status. Younas is one of these children who has shown considerable improvement within a short period of treatment. 

“Now that Younas’s nutritional level has improved and he is moderately malnourished, we will stop giving RUTF and shift him to micronutrient supplementation along with appropriate home based food,” says Sumaira. “His mother has been attending health, hygiene and nutrition sessions and has learnt that real nutrition comes from daily diet which must include essential food groups e.g. eggs, meat, fruits and vegetables.”   
© UNICEF/Pakistan/SamiMalik
There has been a marked improvement in Younas’s nutritional status as he has
moved from SAM to MAM within a period of seven weeks. He is a much healthier
and happier child now.
“Considering the intensity of the low breastfeeding rates and issue of malnutrition in the province and the encouraging results of Nutrition Programme, the Government of Punjab has scaled up Nutrition Programme in 22 district which is more than half of the province,” says Uzma Khurram, Nutrition Officer at UNICEF Punjab. “In Punjab province, more than 36000 LHWs are trained on basic nutrition and Infant and Young Child feeding counselling services and they are performing valuable services within their own communities. We together with Department of Health Government of Punjab are hopeful that with all these efforts the current scenario of malnutrition among under five and for mothers in Punjab will improve over the next few years.”



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