PAKISTAN: Lack of breastfeeding driving high levels of malnutrition

Monday, August 7, 2017 — Q&A on malnutrition in Baluchistan, Pakistan with Eunice Wanjiru Gathiaka, Medical Team Leader
E-Balochistan DMJ Project

How do you explain malnutrition?

Malnutrition is an imbalance between the body’s nutrient requirement versus its intake. There are two main categories of malnutrition generally observed in children; Marasmus and Kwashiorkor. Marasmus is a form of severe malnutrition characterized by energy deficiency due to inadequate caloric intake, while kwashiorkor is protein deficiency despite adequate energy intake. In marasmus the child is wasted and thins out while in Kwashiorkor the body swells due to a lack of protein in the body. In Pakistan, most of children suffer from marasmus. Malnutrition makes children prone to diseases.

What is situation of malnutrition in Pakistan, and especially in DMJ?

Malnutrition is one of the major child health issues in Pakistan. According to Pakistan Demographic and Health Survey 2012-13, around 45% of children show evidence of chronic malnutrition or stunting and 11% are acutely malnourished requiring urgent treatment. In the districts of Naseerabad and Jaffarabad, of  around 19,138 children screened on our three locations, 2,259 were severely malnourished. That’s equal to over 11 per cent. This ratio is alarming, and the concern is that the number is increasing every day.

Why is there such high malnutrition?

It is important to note that there is no food insecurity in this area. Food is easily accessible, although affordability is a concern. The issue is a combination of socio-economic and cultural reasons. Low income, lack of access to health facilities, unhygienic practices, poor health seeking behaviour and unsafe water are some main causes of malnutrition in the area. This is compounded by a poor uptake in breastfeeding.

How important is breastfeeding?

Very important. Medically exclusive breastfeeding is recommended for newborns for the first six months. Breast milk is a safe and balanced diet, with zero contaminants. It’s the right temperature and has anti-bodies which help the child’s body fight against infection. The process of breastfeeding also enhances bonding between the mother and child. If a child is not breastfed, their immunity against disease is compromised. Things like black tea, herbs, honey, goat or formula milk can never compensate breast milk.

Why there is no culture of proper breastfeeding?

Even if mothers breastfeed their children, it is not properly done or done enough. There is a lack of awareness on the importance of breast milk. Due to large families, children often don’t get enough care. We also observe a widespread misconception that colostrum – the first pale yellow milk of mother – is not good for the child. There are also practices of giving black tea, herbs, and powdered milk to newborn babies.

What is MSF doingin Dera Murad Jamali?

In 2008, MSF began working in the eastern districts of Jaffarabad and Naseerabad, supporting primarily nutrition programmes for children under five–years-old in the District Headquarter Hospital in Dera Murad Jamali with a network of mobile clinics and outreach sites. MSF teams support the inpatient therapeutic feeding for complicated malnourished children, general paediatric ward and neonates, as well as ambulatory therapeutic feeding programme, which provides essential medical care to more than 10,000 children annually. MSF’s objective is to improve access to the provision of quality nutrition support to severely malnourished children and lactating mothers.

What is MSF planning to do in future on malnutrition?

It has been observed that many children become malnourished again after treatment. It is because their families continue poor health practices. We want to break this vicious circle. Hence we are also strengthening the preventive component of the project through health promotion activities. These raise awareness about best health practices at a community level, so that the issue is addressed at the root. 

A view of the tents set up where Baz Mohammad and his family lives in a village near Dera Murad Jamali in Balochistan, Pakistan. Photographer: Sara Farid
A mother puts her child in the weighing machine as part of the medical examination at the MSF run ambulatory therapeutic feeding centre (ATFC) at DHQ hospital in Dera Murad Jamali in Balochistan, Pakistan. Photographer: Sara Farid
Mothers with their babies wait outside the ambulatory therapeutic feeding centre<br/>(ATFC) run by MSF at the DHQ hospital, Dera Murad Jamali in Balochistan province,<br/>Pakistan. Photographer: Sara Farid
Women wait to have their babies checked for malnutrition at the mobile clinic run by MSF at Sikandarabad in district Naseerabad in Balochistan province, Pakistan. Photographer: Sara Farid
1 year old Yasin sits in his grandmother's lap at the mobile clinic set up at Sikandarabad, district Naseerabad in Balochistan province, Pakistan. Photoghrapher: Sara Farid
MSF nurse checks the mid-upper arm circumference of young Yasin for indication of malnutrition. Yasin is admitted to the feeding program and is here on a second visit. Photographer: Sara Farid
Muradi hold her eighteenth child as she wait for a checkup at the mobile clinic set up at Sikandarabad, district Naseerabad in Balochistan province, Pakistan. Photographer: Sara Farid
MSF health officer gives plumpy'nut supplement to 1 year old Raiba at the mobile clinic set up at Sikandarabad, district Naseerabad in Balochistan province, Pakistan. Photographer: Sara Farid
A mother holds her severely malnourished daughter's hand as she cries in pain at the children's ward managed by the MSF team at the DHQ hospital in Dera Murad Jamali in Balochistan, Pakistan. Photographer: Sara Farid
Bas Khatoon feeds formula milk to her 3 month old baby at her makeshift house in a village near Dera Murad Jamali in Balochistan, Pakistan. Photographer: Sara Farid
Sara Farid is a professional photographer and journalist. She has worked with leading mainstream media outlets in Pakistan, as well as for international news wires such as Agence France Presse. She is currently working as a freelance photojournalist in and outside Pakistan.