PAKISTAN: New Fears Over Malnutrition

• by Zofeen Ebrahim (karachi)
• Wednesday, March 02, 2011
• Inter Press Service

Upon closer examination, she noticed her thin arms and legs. As she pulled up her dress she saw her protruding spine and the rib cage. Her expressionless eyes and her lethargic disposition made her suspicious.

Hajiani, 30 (who goes by one name), runs a mother and child health centre in her village, Sher Khan Leghari, in district Sanghar, in Sindh province. The centre was set up by Sindh Agricultural and Forestry Workers Coordinating Organisation (SAFWCO), a local non-governmental organisation, in 2005. Since then Hajiani has been looking after the sick mothers and children of the area. 'People know me now and I often visit homes to stay in touch with the community.'

Hajiani convinced Samreen’s mother to bring the child to her centre as she had seen signs of severe malnutrition in the baby.

'She did not weigh more than 5.2 kg,' says Hajiani. In addition, the mother was already eight months pregnant with her fifth child. 'You can imagine how weak the mother was.'

Hajiani decided to put the baby on a high density diet. 'This food was given to us by an NGO called HELP (Health, Education and Literacy Programme) that is treating moderate and severe malnourishment among children in Sindh.

'We’ve had very good results as this is a locally made food supplement, made of lentils, rice, sugar, milk etc and almost tastes like halwa (a local sweet). It costs Rs 2700 (31.70 dollars) for a three-month dose compared to the imported one which is available in the market for Rs 4,000 (47 dollars),' says Dr D.S. Akram, a paediatrician heading HELP.

Two months later, Samreen weighs 5.8kg and Hajiani calls it a success story.

A survey conducted by the Sindh government with support from United Nations Children’s Fund (UNICEF) reveals a grave nutritional crisis among children.

With an estimated 90,000 under-five children malnourished, the survey report published in January shows a global acute malnutrition (GAM) rate of 23.1 percent in children aged six months to five years old in northern Sindh and 21.2 percent in southern Sindh. This area was also the worst affected by the 2010 floods.

'This rate is well above the World Health Organization’s 15 percent emergency threshold level, which triggers a humanitarian response,' UNICEF said in a statement, adding that Sindh was experiencing malnutrition levels similar to those in sub-Saharan Africa.

'I haven't seen levels of malnutrition this bad since the worst famines in Ethiopia, Darfur and Chad,' says UNICEF's deputy representative in Pakistan, Karen Allen on the UNICEF website. 'It's shocking, shockingly bad.'

Following the survey, the government launched a strategic nutrition response plan in collaboration with UNICEF, the World Food Programme and several NGOs in 19 of the 23 districts of Sindh province.

If left untreated, malnourishment can cause irreversible physical and mental damage, warns Akram. Malnourished children are also at a far greater risk of contracting and dying from diarrhoea, pneumonia, respiratory infections and even tuberculosis because they are too weak to fight the disease, she says. 'A malnourished child is ten times more prone to dying of diarrhoea than its healthy counterpart.'

For as long as Hajiani can remember, malnourishment has been around.

Kaiser Bengali, a noted economist, agrees: 'Malnutrition has long been a problem and is intrinsically linked to poverty. The flood just gave the world a peep into the exacerbating poverty that always existed in this part of the country.'

But Hajiani says everything cannot always be blamed on poverty. 'Sometimes I feel mothers are plain negligent, at other times they are unaware. Mothers refuse to wean the child and put him on semi-solids because it’s just so convenient to nurse the infant. Experimenting and trying out newer food for the baby is time-consuming.'

At other times, she says, they are scared that if they start the baby on regular food, the child will fall sick. 'Many times nursing mothers refuse to eat certain foods saying it makes the baby’s tummy ache. I know this is just an old wives tale and most medical books discard this too, but I find such complaints all the time.'

But it is still confounding that an agricultural country where food is plentiful should have so many malnourished children.

'A good harvest does not mean the farmhand will get his share in the produce,' says Bengali.

Researchers say political instability, poverty, inequality, climate and environmental change, and inadequate and poorly administered food security are some of the reasons leading to nutritional crises around the world.

'Many of the countries with high or stagnant stunting levels are among the most fragile politically, having suffered recent wars and internal conflicts,' states a Population Reference Bureau report.

Pakistan seems to be in the throes of all these crises simultaneously.

According to Hajiani, most women who come to her are malnourished but not many people are aware of their condition. 'Most rural women are working in the fields, rearing the livestock as well as taking care of their homes, their children. They hardly care to eat well themselves or provide healthy meals for their children.'

The health ministry is due to carry out a national nutritional survey covering mothers, the elderly elderly and under-fives in March.

© Inter Press Service (2011) — All Rights ReservedOriginal source: Inter Press Service

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