KATHMANDU, NEPAL – Shila is 6 years old. She weighs less than 20 pounds.
Her mother, Bishnu Pariyar, 29, of the western Nepali district of Gorkha, says Shila can hardly walk and cannot sit down on her own. She is bony. Her face is wrinkled. Her hair is thin and unkempt.
Shila has younger brothers and sisters, who are healthier and can walk on their own. But at 6, Shila looks like an infant. Pariyar says she had hoped her oldest daughter would be strong enough to look after her siblings, cook food and help around the house by now. But Shila, the oldest of her children, requires constant care.
"Seeing the pain my daughter is enduring, I sometime mull the idea to commit suicide. I don't know until when I have to carry her on piggyback," says Bishnu wiping her tears with her shawl.
Shila is suffering from a case of severe acute malnutrition. Dr. Rupa Rana, who examined her at Kanti Hospital, Nepal’s only children’s hospital, says she is suffering from a deficiency of calcium and vitamins. "She could not grow up as the lack of calcium and vitamin D in her body is a deterrent to her physical growth,” he says.
Shila is just one of thousands of malnourished children in Nepal. According to the Human Development Report of Nepal 2009, more than half of all children below the age of 5 here are malnourished. Acute malnutrition rates in Nepal are the worst in Asia, with nearly 15 percent of children acutely malnurshed, meaning a child is far below the normal standards of height and weight. In 2001, the rate of acute malnutrition was 9.6 percent.
Local and international activists have flocked to Nepal in recent years, as the problem of malnutrition has become more serious. According to the Ministry of Health, at least 30,000 children die of malnutrition every year. More than 10,000 children suffer from various ailments related to malnutrition including diarrhea and respiratory problems.
Health workers say malnutrition is one the main cause of death for children under five. "If a child is suffering from both malnutrition and diarrhea, there lies very little chance to save his or her life. But when a child is suffering from diarrhea only, it can be easily cured," says Dr. Rameshwor Man Shrestha, director of Kanti Hospital.
Poverty and Illiteracy Fuel the Problem
Nutrition experts say the root causes of malnutrition here are poverty and illiteracy. In particular, advocates say most parents are not educated about nutrition for infants, which fuels the problem.
"As half of the population in Nepal are bereft of two square meals, feeding nutritious food to their children is far cry for those poor parents," says Rekha Adhikari, a dietician at Kanti Hospital. Adhikari says she believes poverty is the major factor that contributes to malnutrition here.
For Shila’s family, that is part of the problem. Her father, Suren Pariyar, is a laborer in their village. He earns 200 rupees per day, $2.90 USD, and feeds a family of seven, including 5 children.
But a stark lack of information combined with often-harmful local lore also contributes, Adhikari says. “It is said in the countryside that children who are [sick] with fever should not be fed greens, only rice. Those ignorant parents keep their sick children hungry," she says.
Pariyar, Shila’s mother, confirms the wives tale. She says she has never fed Shila “green leafs.”
"I know that vegetable[s] should not be served to children [because of] chocking and indigestion,” Pariyar says. “I fed Shila only overcooked salty rice. To my dismay, her body structure decreased rather than growing up."
But the lack of awareness about proper childhood nutrition does not only affect rural, poor families. Raj Kumar Pokharel, chief of the Children’s Health section within the Ministry of Health, says he sees misinformation about nutrition effect children born in well-to-do families too. "Besides poverty, ignorance about balanced food is another contributor to malnutrition. Soybeans and green leafs are available here [in Kathmandu], but locals hardly know about their importance," he says.
Dr. Puspa Raj Sharma, one of only a handful of pediatricians in Nepal, works at Tribhuvan Medicine Study Center in Kathmandu. He says while many infants are malnourished, parents often don’t notice until the child is a toddler and not developing properly.
"In Nepal, mothers do not notice that their children are malnourished in the initial phase. They come to know only after the disease becomes acute. That is why the problem is becoming serious in Nepal," Sharma says.
Pariyar admits she did not become concerned about Shila’s size and health until she was three-years-old. By that point, Sharma says her case of malnutrition had already become acute.
International Organizations Partner to Ease Malnutrition in Hardest Hit Areas
Since 2007, the government of Nepal has been administering Vitamin A drops to children and providing iron capsules to pregnant women at local health posts in an attempt to boost nutrition. But a budget crisis has left just two employees in the Children’s Health section of the Ministry of Health. To complicate matters, according to the Child Work Concerned Center, CWIN, an international organization working for children’s rights here, there is one available pediatrician for every 104,066 children in Nepal.
Earlier this year, Concern Worldwide, an Irish charity, partnered with UNICEF, local NGOs and the Ministry of Health in Nepal to conduct a pilot project to increase access to information and services for malnourished children in some of the hardest hit villages in Nepal. The pilot project trained local health workers and families in conjunction with radio messages to increase sensitization about nutrition.
The project was considered a success, 68 percent of the children who took part were deemed cured, while .34 percent died during the course of the study. The study is likely to be implemented in additional locations throughout Nepal. In the final report published in February, there were two major factors that were sources of concern for the further implementation of the program. One was a high rate of default among participating families – 28 percent of families did not complete the program, which was more than two times higher than expected. And the other primary obstacle to success was the low degree of involvement from government officials within the Ministry of Health.
“The involvement and degree of ownership of the program at a national level is a source of concern,” wrote Saul Guerrero. “Throughout the duration of the pilot, the CHD [Child Health Division of the Ministry of Health] showed limited interest in discussing the performance of the program, or to jointly address programmatic issues with the partners.”
