Life is tough for people living in Tharparkar. Extreme heat in summer, scarcity of food, unsafe and saline drinking water and lack of access to basic health facilities have an adverse effect on the life and wellbeing of communities. People are generally poor, and lack of rain affects their main sources of livelihood, which are agriculture and livestock. As a result, undernutrition is a common problem among children and women. According to the WHO guidelines, if the Global Acute Malnutrition (GAM) rate among children and women is above 15 per cent, it is to be considered an emergency situation. During the National Nutrition Survey conducted in 2011, the GAM rate in the province of Sindh is 17.5 per cent and the Severely Acute Malnutrition (SAM) is 6.6 per cent. Chronic Malnutrition, which could cause stunting, is 49.8 per cent. The GAM rate in Tharparkar District is even higher at 22.7 percent and the Chronic Malnutrition is 45.9 per cent. These statistics present a serious situation and calls for a swift action by the government and its partners to improve the nutritional status of children and women.
For the last many years UNICEF has been supporting the Government of Sindh to counter acute malnutrition through its Community Management of Acute Malnutrition (CMAM) programme. Efforts were accelerated in 2014 after a number of child deaths due to malnutrition were reported in Tharparkar District. Currently, UNICEF’s partner organisations, Shifa Foundation and the Health and Nutrition Development Society (HANDS) are carrying out emergency nutrition activities in 44 Union Councils (UCs) of the district. These activities include screening of children and pregnant and breast-feeding mothers for their nutritional status; provision of micronutrient supplements; conducting awareness sessions on health and nutrition; teaching mother breast-feeding practices and feeding older infants; treatment of SAM and MAM cases through provision of either supplementary food or therapeutic food; referring medically complicated cases to the Stabilization Centres established in hospitals at the district headquarter level. Reaching communities living in hard to access areas is essential for timely detection and raising awareness about malnutrition. Lady Health Workers and Mothers Support Groups play an important role in identifying malnourished children and women and referring them to the CMAM centres. These groups also help young mothers to understand the Infant and Young Child Feeding (IYCF) practices.
Kavita bai (25) works as an IYCF Counsellor for the UNICEF-supported CMAM programme in Tharparkar district. She is the only woman in Meghwar Paro village with a bachelor’s degree and a training certificate in CMAM. During the last two years Kavita has worked with four leading non-governmental organisations (NGOs) working in Tharparkar district with specific focus on malnutrition. She is currently working with UNICEF’s partner organisation, Shifa foundation, and conducts sessions on health, nutrition and IYCF.
“Due to lack of education, awareness about health, hygiene, maternal and neonatal issues is generally low among women in this area,” says Kavita. “However, they are keen to learn and adapt health and hygiene practices that I introduce to them during my sessions. More women now prefer delivering through skilled birth attendants or in the Mithi hospital. They breastfeed their children and are conscious about vaccination. Realising the ill effects of open defecation on health, communities are now constructing latrines in their homes.”
A very important aspect of the CMAM process is taking care of children who suffer from severe acute malnutrition and also have medical complications. Such cases are referred to the Stabilization Centre in the District Headquarter Hospital of Mithi. On the average, around 30 to 40 such cases are brought to the centre every month.
“Treatment for such cases includes administering of antibiotics, folic acid, Vitamin A and multivitamin supplementation, deworming, iron supply, therapeutic milk and food. Recovery usually begins after the third day and the child starts gaining weight after seven days.” - Dr Bhawan Rai p>
The UNICEF Representative in Pakistan, Angela Kearney recently toured Tharparkar district in order to see UNICEF-supported CMAM activities. She visited the nutrition centres in Meghwar Paro and Bhorli Bheel villages and the stabilization centre in the District Headquarter Hospital (DHQ), Mithi. She met the district health officials and urged them to visit communities living in hard to reach areas for a better understanding of their issues and to make health service delivery more effective.
“A lot of good work is in progress but countering the situation of malnutrition in Tharparkar is a daunting challenge,” says Angela Kearney. “Some of the communities in Tharparker are poorest of the poor. With their meagre resources, they can hardly feed themselves and their children. Lack of rain has made the situation worse. Concerted efforts must continue with full vigour to improve the nutritional status of children and women of this area. Raising awareness regarding health and hygiene and helping communities to access basic health services is imperative so that precious lives could be saved. It is our collective responsibility and we must not leave the children and women of Tharparkar alone.”
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