Healing young lives through nutrition interventions
With German support, UNICEF's Integrated Nutrition Programme helps cure malnutrition in infants
Swat, Khyber Pakthukhwa (KP): “He was born very weak, we didn’t think he would survive,” says Hazrat Ali, holding his 19-month-old son, Sudais, in his lap. “I went to every hospital in the area but found no cure for his weakness.”
Three months ago, a severely malnourished Sudais was brought to the UNICEF Integrated Nutrition Programme (INP) at the Civil Hospital Khwazakhaila in Swat. His parents Hazrat Ali, a daily wage labourer and mother, Reham Saim had lost all hope for their child’s survival, after spending most of their meagre earnings on his treatment, but all in vain.
“Anything he ate, he would vomit out or pass-through diarrhea. Even his hair stopped growing,” says Reham, “He had no energy for activity, and all he did was cry.”
Haseena, the Nutrition Assistant at the INP measured his mid upper arm circumference (MUAC) and found it to be only 9.1 cm which is categorized as Severe Acute Malnutrition (SAM). After learning about Sudais’s medical history and under the pediatrician’s guidance, Haseena put him on Ready to Use Therapeutic Food (RUTF) treatment, a life-saving essential supply item that treats severe acute malnutrition in children under 5 years old.
Twice a day Sudais was fed the nutritious paste which provides the required amount of protein and micronutrients, that he was missing out.
“It was the first time we saw him eat something and not throw up,” says Reham. After only a month of taking RUTF, the parents and Haseena noticed a marked improvement in Sudais’s health.
Three months later, Sudais has achieved the MUAC of 12.6 cm. He is now eating solids, walking, playing and is a chatty little fellow, who bosses around his 7-year-old brother in his baby babble.
“Haseena counselled us well,” notes a pleased Hazrat Ali, “even if we missed an appointment, she would encourage us to come for a follow-up.”
Sudais is among 5 million children in Pakistan who suffer from acute malnutrition (wasting) and increasing poverty levels are not helping the situation. The problem of infant malnutrition usually starts at the time of pregnancy. Maintaining the mother’s health with preventive care is essential to addressing the root cause of malnourishment.
In Reham’s case, she lost a baby girl, her second born, about four years ago due to a congenital heart disease. She says she has been in depression since then and was unable to take care of herself while she was pregnant with Sudais. That, coupled with their dwindling financial resources, led to her own malnourishment.
Unfortunately, Reham also lacked awareness on the importance of exclusively breastfeeding a baby for the first six months of their life. She had no proper guidance on how to breastfeed successfully and ended up missing the crucial time frame during which the baby develops their strength, brain, and immune system.
“About a month after Sudais was born, I stopped producing milk and was unable to breastfeed him,” shares Reham, “My depression became worse as I saw his condition worsen.”
Doctors had prescribed him formula milk which they could not afford, so sometimes they would feed him watered-down buffalo milk, which can be heavy on the stomach of an immune-compromised infant. The milk was expensive too. Most often they would rely on feeding him a milky black tea, which made matters worse for the baby.
Khais Meena, mother of 15-month-old, Muskan faced similar issues before she brought her to THQ Hospital in Barikot, Swat. In October 2022, when Muskan was 7 months old, her MUAC measurement was at 7.8 cm weighing a mere 3.5 kg.
“She was on the verge of death when I brought her here,” remembers Khais Meena.
Dr. Fakhr-e-Alam, the Medical Superintendent at the THQ referred her to the UNICEF INP where she also received lifesaving RUTF treatment.
“We see a lot of severe and moderate acute malnutrition cases here,” states Dr. Alam. “It’s mostly due to the low literacy rates, poverty and more recently the economic crisis.”
“Traditionally, the mothers are not well fed. We try to counsel the expectant mother, her husband and mother-in-law on the importance of the mother’s nutrition and diet for the baby.”
At a current MUAC of 13, Muskan now plays and eats all sorts of foods easily, as she continues to grow stronger. “She loved the taste of the RUTF and would happily consume the entire sachet,” says Khais Meena, grateful for her daughter’s recovery.
Since 2020, the German Federal Foreign Office (GFFO) has funded UNICEF’s Integrated Nutrition Programme in KP. Nearly 225,000 children between the ages of 6-59 months have been screened for malnutrition, in six different districts of the province. Of those, almost 15,000 severely malnourished children have been treated with RUTF, while mobile teams and static sites have been able to provide over 161,000 children with other micronutrient supplements.
The INP has also been working on preventive care for pregnant and lactating women. It has provided over 46,000 such women with micronutrient and iron/folic acid tablets. Additionally, essential lifesaving information related to nutrition, health and WASH, including infant and young child feeding, key family care practices, immunization and personal hygiene has been disbursed to almost 190,000 mothers and caregivers. Almost 700 mother support groups and over 250 father support groups have been established in the flood affected areas of KP in order to reach a larger audience for the awareness messages, which has helped sustain the impact of the programme.
