Fighting malnutrition in Pakistan with a helping hand from children abroad

Without immediate intervention the threat of stunting could begin to increase in future.

By A. Sami Malik
10-month-old Younas holds a Ready-to-Use Therapeutic Food (RUTF) sachet.
UNICEF Pakistan2016/Malik
07 July 2016

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, Southern Punjab, 7 July 2016 – It was only seven weeks ago that Haseena Fiyyaz walked into the Mehmood Kot Basic Health Unit (BHU) with her 10-month-old boy, Younas, in her arms. One could easily see that not only was the child frail and underweight, but so was the mother.

“My boy has become weak, cries a lot and is lazy all the time”, said Haseena, explaining her child’s condition to the Lady Health Worker (LHW), Sumaira Yasmeen. “I breastfeed him and also give him buffalo milk, but he keeps getting diarrhoea and is losing weight day by day.”

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.

A health worker measures Younas's mid-upper arm circumference
UNICEF Pakistan/2016/Zaidi
A health worker measures Younas's mid-upper arm circumference (MUAC) at UNICEF-supported nutrition centre. Measurements from his MUAC, weight and length showed that Younas was suffering from Severe Acute Malnutrition (SAM).

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

Seven weeks later, after doing a follow-up check on Younas, Sumaira was delighted to see that his MUAC measurement has improved from 10.5 to 11.5 centimetres, and his weight has increased from 5.7 to 6.6 kg. Overall, his nutritional status had improved from SAM to Moderately Acute Malnutrition (MAM).

Breaking the cycle of malnutrition

“Every month, 20 to 25 new children are registered in the OTP”, said 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 and 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.”

Malnutrition is a major issue for women and children, especially in rural areas of Pakistan. It has a direct correlation with infant and young child feeding and hygiene practices. If a pregnant woman is malnourished, the child is likely to be born underweight, making her or him susceptible to infections, malnourishment, and eventual death. Exclusive breastfeeding for the first six months is vital to preventing malnutrition in newborns. If possible, it should continue until the child is two years of age. 

A health worker measures Younas's mid-upper arm circumference
UNICEF Pakistan/2016/Zaidi
Sajdda Bibi, a Lady Health Worker (LHW) conducts a hygiene, nutrition and breastfeeding awareness session for a group of women and children in a health house in Muzaffargarh district, Pakistan. These sessions are part of a larger effort by UNICEF and the Government to improve rates of malnutrition in the Punjab province.

Pakistan has the worst breastfeeding indicators in South Asia, and Punjab has the worst breastfeeding indicators in Pakistan. In 18 of the 36 districts of Punjab, over 4,000 severely acute malnourished children are registered in the OTP every month. Food insecurity, maternal undernutrition, disease and illness, inadequate health services and lack of awareness about feeding and healthcare practices are the main reasons for malnutrition in children. 

To help reverse these trends, the Government of Punjab’s Department of Health has launched an Integrated Reproductive Maternal Neonatal Child Health and Nutrition (IRMNCH&N) Programme. UNICEF is supporting the nutrition component of the programme, which includes screening children and pregnant and breastfeeding mothers to check their nutritional status; providing micronutrient supplements; conducting awareness sessions on health, hygiene and nutrition; counselling mothers about breastfeeding practices; and treating acute malnutrition. 

“If a mother is breastfeeding, her own nutritional status has a direct bearing on that of the child”, said Abida Nasreen, Assistant District Coordinator of the 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.”

For the overall effectiveness of the nutrition programme and in particular the OTP, adequate and regular supply of RUTF and micronutrients is essential. UNICEF procures a major part of the RUTF for the Government of Pakistan.

When Younas and his mother returned to the Basic Health Unit
UNICEF Pakistan2016/Malik
When Younas and his mother returned to the Basic Health Unit seven weeks after his original consultation, his MUAC measurement had improved and his weight had increased.
A helping hand from children abroad

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

The RUTF that was procured through the Kidpower UK donation is being used in five Union Councils (administrative area) of the 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 supplies of RUTF to improve their nutritional statuses. Younas is one of the 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”, said 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.”     

After the encouraging results of Nutrition Programme, the Government of Punjab has scaled up the programme in 22 districts – more than half of the province. This expansion is particularly important considering the intensity of the low breastfeeding rates and issue of malnutrition in the area. “In Punjab province, more than 36,000 LHWs are trained on basic nutrition and infant and young child feeding counselling services and they are performing valuable services within their own communities”, said Uzma Khurram, Nutrition Officer at UNICEF Punjab. “We together with Department of Health Government of Punjab are hopeful that with all these efforts, the current scenario of malnutrition among under-five [children] and for mothers in Punjab will improve over the next few years.”