Tharparkar district has the lowest Human Development Index in Sindh Province (in 2005 it was 0.3140) in Pakistan. As a result of famine and drought in Tharparkar, at least 464 children have died during the last nine months, including children less than five years old. Malnutrition, low birth weight, lack of emergency medical support and proper care at home were cited as the main causes for this huge death toll. PNDS realizing its social responsibility decided to set-up a Relief Camp at Tharparkar district in order to assess the nutrition situation, availability of food and related resources.
A preliminary visit was undertaken by a group of PNDS members on 13th November 2014 to a remote village named Haryaar in Mithi district of Tharparkar. This village had no health facilities available for the people living in the area. The PNDS camp was set up in one of the local schools. 4 public health nutritionists, 2 dietitians and 2 pediatricians volunteered for this camp. Logistical services were given by Mr.Hansand members of the local community.
Subsequent to our preliminary visit to Tharparkar, discussion with the executive members of PNDS was held to draw plans for the continuation of this activity. It was decided that visits to other villages in the Tharparkar should also be done to have a better picture of nutrition status in the Tharparkar region. The 2nd visit was planned to Bhorilo village (consisting of 500 houses) on 9th January 2015 in collaboration with the volunteers from Dhoraji Youth Services Foundation (DYSF). Women with children under five years were invited to the camp. We measured weight, height & mid upper arm circumference (MUAC) to assess their nutritional status. A brief interviewer-assisted questionnaire was used to gather information about dietary intake, vaccination and illnesses. The doctor in the team examined and reviewed disease history along with the nutritionist who counseled the pregnant and lactating mothers regarding safe, low cost and appropriate feeding procedures. Mothers were instructed to start weaning the child at 6 months using homemade soft food under hygienic conditions. Tips to curtail cost using homemade foods were included as part of the counseling process.
Nutritional intervention included the provision of Vitamin A & D drops, zinc, multivitamins, iron syrup & ORS. Preparing and cooking of local healthy weaning foods such as khitchree, soji kheer, sagodana, etc, were demonstrated by PNDS team. Prepared samples of each of these foods were shown to mothers. As part of the services from PNDS, donation of 250 ration bags containing flour, rice, sugar and lentils were distributed. Packets of khitchree, sagodana, soji, peanuts, milk, butter, jam, oil & sugar were also distributed among mothers of children under five years.
Our conclusion based on two visits to the Tharparkar village was that there are many non-nutritional factors which are contributing to food insecurity and malnutrition in children and women. For example, water scarcity, lack of employment & education. Daily meals for majority of the people living in these villages include roti (Pakistani bread) and chatni (green chilies paste). Infants are breast fed with no weaning till 2 years and over. Fruits and vegetables cannot be grown locally due to unavailability of water and therefore they are not a part of their diets. Among 100 children who were assessed, only 2-3 were consuming vegetables like potato and fruits like banana, orange or apple occasionally. Eating clay and non-food items were also practiced among the people and this further augmented the malnutrition status of children and reproductive women in general. And finally there was no medical facility available and the nearest health care facility was 1-2 hours’ drive. There are 5-6 wells in the village and the water is drawn out of wells with the help of camels and cows. Women are responsible to bring water to their homes from the wells.
Recommendations made by PNDS Team:
Other than the basic necessities like clean drinking water, food, education and job opportunities, there should be a provision for basic health facilities at community level where people can have easy access and don’t have to travel long distances. Education and nutrition counseling should be included in health initiatives. During training of health care workers, nutritionists should be employed to provide training on weaning and feeding practices.
President, Pakistan Nutrition and Dietetic Society (PNDS)
GLIMPSES OF PNDS CAMPS AT THARPARKAR VILLAGES