Tackling malnutrition during COVID-19

A health worker’s determination to keep all children healthy and thriving

Abdul Sami Malik
01 June 2022

JAFFARABAD, Pakistan: “Helping women and children overcome their nutrition deficiencies has helped me overcome my personal challenges in life,” says 22-year-old Rabia Khatoon, a Nutrition Assistant at one of the Basic Health Units in Jaffarabad, a district of Pakistan in the south western Balochistan province. 

Portrait of a working nutrition assistant lady from Balochistan province of Pakistan
UNICEF/UN0639355/Sami Malik
Rabia Khatoon (22) is a Nutrition Assistant at the Basic Health Unit, Allah Yar Khosa, in village Manzoor Khan Khosa of Jaffarabad district in Balochistan.

Rabia grew up in a poor family. Despite immense family pressure, she continued her learning and is the first of three siblings to study beyond the primary level. She is now one exam away from completing her bachelor’s in science degree. Rabia also completed a two-year course to become a Lady Health Visitor and is now actively helping women and children in her province.

“It was challenging to pursue higher education in a culture where girls’ education is not viewed as a priority,” says Rabia. “I got married at the age of 20 and gave birth to a baby girl a year later. I continued working during my pregnancy and moved from village-to-village with my mobile nutrition team to screen and treat children and women for malnutrition. I am determined to continue to learn and work. I dream of the day when all girls will be educated, and no child or mother will suffer from undernutrition.”

Fortunately, her husband, Sadiq, has always been supportive of Rabia’s work. Every day, Sadiq drives nearly 17 kilometres each way on his motorbike to drop off and pick up Rabia.

A woman with a man on a motorcycle outside a basic health unit
UNICEF/Pakistan/2022/Sami Malik
Rabia with her husband.

Summers in Pakistan are brutal with the mercury rising to the high forties, even fifties. The temperature outside is a scorching 49 degrees Celsius. The frequent power cuts since morning added to the woes. Rabia patiently sits behind her desk despite the harsh conditions, greeting children and women with a smile. She then proceeds to collect the information and screen children and women for malnutrition.

36-year-old As Lal Bibi and her ten-month-old baby girl Zarrine wait patiently for their turn at the Health Unit. Her family belong to the Baroch who are among the most marginalized rural communities in Pakistan. Decades of abject poverty and deep-seeded conservative beliefs have left the tribe trailing on all aspects of socio-economic growth, fuelling rising cases of severe acute malnutrition among children, illiteracy and unhygienic lifestyles.

Mid upper arm circumference of an infant girl is being checked to determine her nutrition status
UNICEF/UN0639358/Sami Malik
Zarrien (10 months) is being scanned using the Mid Upper Arm Circumference (MUAC) method which shows the child’s Severely Acute Malnutrition (SAM) status at the Basic Health Unit, Allah Yar Khosa in Jaffarabad District of Balochistan province in Pakistan.

Lal Bibi first learned about her child’s malnutrition when a Social Mobilizer met her at home. She was urged to urgently visit the Health Unit. Zarrine, Lal Bibi’s seventh child, was diagnosed with Severe Acute Malnutrition and given a week’s supply of ready-to-use therapeutic food or RUFT – a highly-nutrition food paste supplement. This was a week ago. Rabia measures Zarrine’s weight and her Mid-Upper-Arm Circumference and is relieved to see the improvement. Next Rabia checks Lal Bibi prescribes iron supplements to treat anaemia.

Woman hands out Folic acid tablets (Iron Supplement) to another woman as children in the background look to the camera
UNICEF/UN0639360/Sami Malik
Rabia hands out Folic acid tablets (Iron Supplement) to Lal bibi (36), who has been screened as iron deficient and her nutrition status is below the desired level.

In 2020, UNICEF introduced fresh efforts to revamp prevention and treatment services to cope with the rising cases of severe acute malnutrition among children and women in Pakistan. The project was launched in Jaffarabad district, with financial support from the European Civil Protection and Humanitarian Aid Operations (ECHO). 

Since the project’s launch, nearly 35,000 under-five children have been screened for malnutrition as part of the project. More than 5,000 children have been given RUTF as a treatment against severe acute malnutrition. In addition, nearly 30,000 mothers and caretakers benefited from awareness-raising sessions on Infant and Young Child feeding.

“It gives me immense pleasure when the nutrition level of a child improves or when a mother tells me that she has started to feel better after treatment,” says Rabia. “We need similar projects  in every district of Balochistan to help improve nutrition status of children and mothers. I am sure, many others like me, would step forward to work and support these projects.”

Mother with her two children as one tries to bite a packet of ready to use therapeutic food for malnourished children
UNICEF/UN0639369/Sami Malik
Ten-month-old baby girl Zarrine, diagnosed for severely acute malnutrition, eating the nutritious Ready-to-Use Therapeutic Food (RUTF) supplement.

Malnutrition and anaemia among children and women in Pakistan, particularly in rural communities, have been consistently high for decades. The number of children exclusively breastfed is alarmingly low, driving high rates of stunting and wasting, which prevent a child’s normal development and survival. The estimated number of children with Severe Acute Malnutrition is nearly 2.5 million. Nearly 12 million children are stunted. Over half of adolescent girls and about 40 per cent of women of childbearing age are anaemic. If a pregnant woman is malnourished, her child is more likely to be born with low birthweight, making babies more susceptible to infections and jeopardizing their survival.

The onset of the COVID-19 pandemic and the related disruptions to critical nutrition services further exacerbated the situation.  “As the word spread that the COVID-19 virus was contagious, people stopped coming to the health centres,” says Ghulam Sarwar, who works at Allah Yar Khosa Basic Health Unit in Manzoor Khan Khosa village, Balochistan. “Women were no longer attending the outreach screenings and nutrition, health and hygiene sessions which we were organizing in communities every week. Neither would they let our staff enter their houses to screen their children.”

The project introduced counselling services targeting pregnant and lactating women to promote exclusive breastfeeding. Likewise, UNICEF mobilized Social Mobilizers and Health Workers and partnered with community elders and religious leaders to improve the nutrition and health of women and children in the most vulnerable and most hard-to-reach communities. The project also supported the provision of nutrition services such as screening children aged from six months to five years old for malnutrition; the early detection and management of cases of severe wasting; the training of health care providers on simplified procedures for Community Management of Acute Malnutrition; and capacity building of nutrition data management staff.

Parallelly, the project helped communities to adopt safety measures against COVID-19, including regular handwashing, use of face masks and maintaining safe physical distance. The project provided weighing machines, delivery kits and tables, etc. to aid front-line workers to continue delivering essential nutrition services.