Malnutrition, Interventions

1. Dr. M Rehan Khan (DVM,MS)
FCCU

2.  We know that malnutrition is(lack of proper nutrition, caused by not having enough to eat, or eating enough of the
right things)
 Lack of food: this is common among the low income group
 No enough nutrients
 Among children lack of knowledge of adequate feeding among parents.
 Diarrhea
 Livestock diseases (sheep pox)

3.  lack of appetite
 tiredness
 always feeling cold
 loss of fat, muscle mass, and body tissue
 skin may become thin, dry, inelastic, pale, and cold.

5.  Pakistan, a lower middle-income country with the sixth largest population in the world, has an exceptionally high
level of child undernutrition.
 Stunting prevalence, at 45%, ranks 124 out of 132 countries. By contrast, the country is ranked 11th of 118 countries
on the hunger index. One of the major contributing factors to the poor nutrition situation is natural disasters; a
consequence of climate change, the country has experienced 63 natural disasters from 1935 till 2011.
 The frequency of drought affecting the country is increasing, due to a gradual increase in temperatures.

6. frequency
Floods
windstrom
Drought
Other

7.  Vaccination of animals was initiated by LnDD
 WHO, WFP, UNICEF have prioritized Tharparkar because of high malnutrition rates till date many children have
been admitted at the Nutrition Stabilization Centre (NSC) at DHQ Hospital Mithi due to SAM (Severe Acute
Malnutrition) with complications. The mortality in the NSC was due to the fact that the child was suffering from
Cerebral Palsy. WHO has provided Equipment for the Nutrition Stabilization Centre along with medicine kit and
therapeutic feeds.

9. INTEGRATED MULTI-
SECTORAL INTERVENTION:
 Concern Worldwide and Deutsche Welthungerhilfe (WHH), funded by ECHO.
 Principal project goal “was to improve resilience of the drought affected population in Sindh Province”.
 More specifically, the project aimed to meet immediate humanitarian needs of drought affected communities through
an integrated Nutrition, Food Security and Livelihoods (FSL) and Water, Sanitation and Hygiene (WASH) response in
Umerkot and Tharparkar Districts.
 The project aimed to reduce the prevalence of acute malnutrition through nutrition-specific interventions .

10.  Concern Worldwide implemented a nutrition specific response, targeting children under five years and pregnant and
lactating women (PLW).
 Quality treatment was provided to severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) cases
and moderately malnourished PLW, at the community level, through mobile teams. SAM children with complications
were treated in the stabilization centers (SCs) established with the support of Concern Worldwide in the district
headquarter hospitals .
 Orientation sessions (one to one and in groups) were held.
 During the project life, 61,693 children under 5 years and 27,494 PLW were screened. A total of 6,071 SAM cases,
11,395 MAM children and 9,201 malnourished PLW were treated in the CMAM programme .

11.  Nutrition-sensitive interventions involved : A mix of quantitative and qualitative methods was used including
household interviews, collection of health-related data from government health facilities and focus group discussions
(FGDs). Food security and livelihoods related interventions were designed to increase access of the targeted
beneficiaries to adequate and diversified food through appropriate activities.
 Provision of cash through Cash for Training (CfT) (nutrition, agriculture and livestock management) to the drought
affected malnourished households.
 Provision of livestock assistance, involving vaccination and deworming, livestock management sessions and clinics
with the support of the government livestock department. 100% of beneficiaries mentioned increase in milk
production.
Nutrition Agriculture Livestock

12.  District selection:
Based on the guidance from PDMA/needs
assessments of UN agencies
 Sub-district selection:
Based on severity of drought affects identified from
various drought assessment reports
 Village selection:
Nutritional hotspot villages based on high GAM rates
identified through screening
 Individual beneficiary selection:
Household having a case of undernutrition and
registered under the CMAM programme and/or
households falling under very poor and poor wealth
rankings as per HEA.
Nutrition-sensitive targeting was largely determined
by the nutrition-specific component, whereby
households with children enrolled in the CMAM
programme were referred to the FSL and WASH
services. The project aimed to reach at least 80% of the
households out of the nutrition case load in the
nutrition ‘hotspots’ and support these households
through FSL and WASH interventions .Geographic
targeting within the selected tehsils also followed the
nutritional ‘hotspot’ approach. This involved screening
of all children (6 – 59 months) to calculate a village
GAM prevalence; those with the highest GAM rate
were selected for the intervention .

13. (WASH)
 Access to drinking water (solar water pumping machines )
 Hygiene promotion (critical times and appropriate methods for hand washing, personal and household hygiene and
water treatment at household level ) 11% of households reported washing their hands during all five critical times
(compared to none at baseline), of whom 44% used soap and the remainder used local sand and water. And trained
Community Outreach Workers
 Construction of low cost latrines .(Only 28%)
success

14. SUCCESS OF THE
PROJECT:
Indicator Target value Final Progress value
% of children with SAM
having access to appropriate
treatment including
therapeutic food.
>50% 55%
% of children (0-5 months of
age) who are fed exclusively
with breast milk
65% 75%
% of the target population
achieves Acceptable Food
Consumption Score (FCS).
38% 58%
Prevalence of water-borne
and water-related diseases
in targeted population.
<50% 27%
Nutrition
specific
Nutrition
Sensitive

15.  Cash compensation on livestock mortality .
 Cost effective fodder.
 Ensure accessible and affordable veterinary services.
 Rain water harvesting techniques .
 Seed distribution through seed bank.
 Drip irrigation .
 Availability of fertilizers on low cost.

16.  Food Security (Community level storage should be constructed and maintained and ensure SCM for necessary food
items suck as fruits, vegetables and milk products at low prices for prolong durations.
 Health Services (Primary, secondary and tertiary health care facilities with essential equipment ,trained personnel
and support staff.
 Communication through mass media .And availability of transport system at lower cost or free.

17.  livestock department is providing the veterinary care services with limited resources.
 Lack of coordination of relevant stakeholders .
 Crop failure due to low rainfall
 Unable to cover all the effected population.
 Extreme weather conditions (high temperatures)
 costly and time-consuming transportation
 Mitigation ?

18.  https://reliefweb.int/report/pakistan/pakistan-nutrition-food-security-and-
livelihood-emergency-tharparkar-district-sindh
 Multi-sectoral nutrition sensitive response to drought emergency in Sindh,
Pakistan
 Pakistan- Tharparkar Crisis: Overview, Response, Damages as of March 12
2014(WHO)