NORTH WEST FRONTIER PROVINCE, Pakistan, 12 June 2007 - At the brand new supplementary feeding centre in Attarshesha, Salma, 22, checks Usman's weight and height. The four-year-old boy stares at the 'Lady Health Visitor' , his eyes wide open.
He looks intimidated and does not risk a move as the young woman briskly takes him from the scales to the measuring board, and back onto his mother's lap. Usman weighs 11 kg and is 93 centimetres high.
"Your son is malnourished", Salma tells his mother, Yasmeen. "For the same height, his weight should be 13.5 kg." She hands Yasmeen a plastic container filled with Unimix, a nutritious fortified flour, explaining that Unimix can be used to prepare foods such as paratha bread, halwa (a local desert), porridge and cookies by mixing it with oil, water, flour and sugar.
"Usman should have it four to five times a day, in addition to regular meals," says Salma, adding with a smile: "This will help to improve his weight and reduce the deficiency in vitamins and minerals."
Clinic treats undernourished children
The Attarshesha clinic is one of 50 centres for nutrition surveillance and supplementary feeding supported by UNICEF and its partners in rural areas as part of a two-year earthquake recovery plan here. The plan was put into effect following the October 2005 quake in the region that claimed the lives of over 73,000 people and displaced thousands more.
The clinic treats mildly and moderately malnourished children who weigh between 70 and 80 per cent of the average weight for their height. Moderately malnourished children from six months to five years of age, as well as pregnant and lactating mothers, each receive 35 kg of Unimix for a period of four months.
Clinic services are provided free of charge. UNICEF pays the salary of the Lady Health Visitor and provides food supplements, drugs and medical equipment. Severe cases are referred to a therapeutic feeding centre, a 40-minute drive away, which treats acute and chronic malnutrition.
"Malnutrition was an issue in the district even before the earthquake, as 34 per cent of children were underweight," explains UNICEF's Nutrition Officer in Abbotabad, Dr. Bilal Ahmed. "A health and nutrition survey conducted right after the earthquake revealed that 38 per cent of children were malnourished as communities had even less access to food, water and basic sanitation facilities".
A case of severe malnutrition
A woman and her daughter enter the consultation room and Salma's face stiffens. She checks the nearly five-year-old girl's upper arm circumference, as well as her height and weight. At 107 centimetres high, Shanza weighs 12.2 kg, less than 70 per cent of the average weight for her height.
"Your daughter suffers from severe malnutrition," Salma tells the mother, Flaynisa. "Her life is in danger and requires urgent medical attention. You will have to visit a therapeutic feeding centre as soon as possible. If you face any problem, let us know. We will do our best to support you."
Since Attarshesha's supplementary feeding centre opened, this is the third case of severe malnutrition the clinic's team has come across.
While rocking her daughter's frail body, Flaynisa offers a bleak insight into her life. "We have no sustainable means of income. My husband is a labourer at construction sites," she says. "Sometimes he finds work, sometimes he doesn't.
"I have seven children and it is very difficult to meet the needs of everyone when we do not have a regular income," Flaynisa continues. "We eat three times a day though - rice, wheat, maize and potatoes, but no meat."
Network of community health workers
"There are many factors leading to malnutrition", says Dr. Atta Ur-Rehman, Field Medical Coordinator for the nutrition programme run by Relief International, an implementing partner for UNICEF. "Poor diet, scarcity of food, low literacy levels and lack of sensitization to nutrition issues are just a few of them. Also, parents often show preference for their sons rather than their daughters when it comes to food, as well as access to health services."
To tackle this long-standing problem, UNICEF and its partners are conducting awareness sessions on nutrition at the community level, involving religious leaders, mothers and 'nazims' (local political leaders).
UNICEF is also establishing a network of 4,000 community-based health workers whose priorities are to sensitize communities on basic health and hygiene practices, and to detect cases of malnutrition for referral to the supplementary feeding centres.
"I feel grateful I have been told early enough that my daughter needs special care," says Flaynisa. "I felt so helpless when I came to the centre. Now I know we are in good hands and I will do my best to give Shanza what she needs."