Hailing from Gharo, Lachmi, aged two months and weighing just eight kilogrammes, was brought to our clinic by her very worried mother, who reported that she was not able to breastfeed Lachmi as she could not afford meals most days.
Lachmi underwent various tests before being diagnosed with Severe Acute Malnutrition (SAM). She was given 12 sachets of Ready-to-Use Therapeutic Food (RUTF) regularly for a few weeks, after which Lachmi returned with significant improvements in her general wellbeing. There was a 20 percent increase in her Mid Upper Arm Circumference (MUAC) — a key malnutrition indicator for health workers — and weight.
But Lachmi’s is not the only story. Malnutrition in Pakistan has been on the rise for many years.
CHILDREN AT RISK
According to the National Nutrition Survey conducted in 2018, 40.2 percent of children under the age of five in Pakistan have stunted growth — that is, nearly half of the children in Pakistan under the age of five. Statistics also reveal that 29.8 percent are underweight and 30 percent of these children suffer from wasting, which is defined by low weight-to-height ratio.
The international community has set emergency wasting thresholds at 15 percent. Pakistan’s wasting rate alarmingly exceeds that, as it is currently 17.7 percent. Malnutrition can be a deathly disease if it is not treated in time.
Within Pakistan, millions of vulnerable individuals, especially children and women, silently bear the consequences of malnutrition. Malnutrition weakens the immune system, making individuals more susceptible to diseases and hampers cognitive development, perpetuating a cycle of poverty and underdevelopment.
The World Health Organisation (WHO) has found that 45 percent of children’s deaths worldwide are associated with undernutrition. This condition leads to a state of mineral and vitamin deficiency in the body, which can cause many serious diseases, if proper nutrition is not administered.
According to the United Nations Children’s Fund (Unicef), around 10 million children in Pakistan suffer from stunted growth. Stunting — one of the most common diseases among children in Pakistan — is a condition in which a child cannot grow to the proper height according to their age.
It is highly likely that underweight children suffer due to micronutrient deficiencies caused by a lack of vitamins and minerals. These nutrients are required for body functions, such as the production of enzymes, hormones and other substances, and are necessary for growth and development.
According to a 2023 report published by Office for the Coordination of Humanitarian Affairs (Ocha), one-third of children in Pakistan aged six to 23 months suffer from moderate acute malnutrition (MAM).
What makes matters worse is that the devastating floods of 2022 worsened malnutrition levels in children. In 2023, Ocha conducted a survey in 15 flood-affected districts that concluded that the number of children suffering from wasting in Pakistan’s flood-affected areas has increased in comparison to the pre-flood situation, which was already reaching emergency levels.
INTERVENTIONS AND EXPERIENCES
The Malnutrition Programme, which started in 2012 at Gharo, aims to screen and rescue children suffering from SAM. The Community Outreach Programme, looking after 490 households, works in conjunction with the malnutrition programme and screens children using a basic health questionnaire and through physical examination. Those who are identified as malnourished are referred to our clinic, the Shine Humanity Gharo Clinic.
The identification and screening of children who are suffering from SAM and MAM in Gharo is done using standardised survey tools. A team of nurses check the basics such as weight, height and upper arm measurement and then categorise the children into various categories of malnutrition.
Based on the findings, children are then prescribed special food which does not need any preparation and can easily be consumed like a paste. Parents are asked to visit the clinic after a few weeks to measure the progress of the child and are then again prescribed treatment, which usually lasts six weeks.
In the month of June, we identified 11 children suffering from malnutrition, all of whom are now undergoing treatment. Children in the ‘Red Zone’ — that is those children suffering from SAM — are given the specialised food once a day for a month and then called for a follow-up. The children are then screened for SAM through a malnutrition assessment questionnaire and general physical examination, followed by a MUAC assessment.
People in the rural areas of Pakistan are mostly overlooked when it comes to basic healthcare services, and the provision of primary healthcare and the availability of resources is scarce in these areas.
Since 2013, our Gharo clinic has helped in providing primary healthcare to the population of Gharo and its surrounding villages. We have compelling evidence to suggest that the optimal utilisation of RUTF has yielded remarkable outcomes in addressing acute malnutrition among children. Our approach involves initially treating the child’s health comprehensively with a combination of RUTF, breastfeeding and carefully prepared home recipes.
The results we have observed are truly exceptional, showcasing significant improvements in the health and well-being of the children. This integrated strategy highlights the effectiveness of combining targeted interventions to combat acute malnutrition and enhance overall child health.
In accordance with these findings, we have been able to help many children in the community. For instance, Rohak, a one-year-and-eight-months-old male child was recently brought to our clinic and thoroughly evaluated by our team, who found that he was in the grip of severe malnutrition. His weight was just five kilogrammes when it should have been at least eight.
As per our guidelines, he was prescribed our ready to use sachets for four weeks. Unfortunately, he has a history of succumbing to fits, due to which his intake of the sachets has not been optimum. Nevertheless, he is now slowly becoming healthier.
CHALLENGES AND OBSTACLES
However, the RUTF can be given for no more than 12 weeks. It’s an energy dense, micronutrient paste made using peanuts, sugar, milk powder, oil, vitamins and minerals and, therefore, if used longer, it may damage the child’s organs.
Unfortunately, the agony of poverty forces many parents to feed all their children, whether malnourished or not, this paste. They often treat it like sweet chocolate, ignoring the fact that it is only meant for the malnourished.
The government has to play a key role in addressing malnutrition, anaemia and stunted growth across Pakistan to ensure healthy babies and households. All the NGOs and social workers working in rural areas, especially in Tharparkar, have to pay urgent attention to save hundreds of lives. The government and agencies should focus on and educate people about family planning, the importance of breastfeeding, consuming relatively cheaper but high mineral/vitamin foods, and the importance of immunisation.
We must address malnutrition as early as possible, since a child’s brain is 80 percent developed before most children even start going to kindergarten. Incredibly, the brain doubles in size during the child’s first year. It grows to about 80 percent of the adult-size brain by age three and 90 percent — nearly full grown — by age five.
The brain is the command centre of the human body and needs energy to properly work, which is why it consumes 20 percent of the body’s energy, despite being only two percent of the body weight. If we neglect this aspect of children’s growth in their early years, and let them fall prey to malnutrition, we as a nation should hang our heads in shame.
The writer is the director of Shine Humanity and is also head of the Malnutrition Programme, Sindh
Acknowledgement/ Reference: Published in Daily Dawn, EOS on August 13th, 2023