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HEALTH-NEPAL: Custom, Ignorance Breed Severe Malnutrition

Suman Pradhan

KANCHANPUR, Sep 22 2006 (IPS) - In Nepal’s western terai (plains) districts, a silent epidemic is brewing. Children and women are racked by diseases arising from malnutrition and anaemia-not because of a lack of food but because of faulty food habits and traditional customs, say health workers in the region.

The situation is alarming. Every day at the zonal hospital in Mahendranagar in Kanchanpur district, Dr Subhesh Kayastha sees hundreds of patients who come for treatment from all over the district and beyond. Many children are thin and ‘wasted’ and present a frightening picture.

”Kids come here with classic symptoms of Protein Energy Malnutrition (PEM),” says Kayastha. ”It is widespread among children under five years of age in this area.”

A recent assessment by United Nations Children’s Fund (UNICEF) in Kanchanpur found that 21 percent of children are afflicted with wasting, an indicator of acute general malnutrition. The prevalence rate is “almost twice the national average found in Demographic Health Survey conducted in 2001”, says the study.

The assessment concludes that though the prevalence of wasting is high, ”one should not immediately relate it to the situation in some African countries and conclude that it is due to food shortage. It is due to inadequate care, poor feeding habits and poor hygiene and sanitation which increases the disease burden on the young children.”

A severely malnourished child presents a frightening picture, though the treatment is simple and prevention is even simpler. All it requires, say health workers, is a little awareness among the parents.

“It’s not because these families can’t feed their children,” says nursing inspector at the Mahendranagar hospital Indudhir Paudyal. “There is enough food and most parents can afford that. Indeed, they feed the children rice and milk. But lack of a balanced diet is causing this problem.”

Nepal is a desperately poor country where the per capita annual income hovers around 230 US dollars. Many of its 26 million people survive on less than a dollar a day. However, the terai plains where malnutrition is rife is also Nepal’s breadbasket where food is aplenty. But low literacy rates, especially among mothers, and rigid tradition stand in the way of a healthy diet.

In the nearby Bardiya and Banke districts of western Nepal, the situation is similar to Kanchanpur. At a 17-bed nutritional centre run jointly by the Banke district hospital and Nepal Youth Opportunity Foundation (NYOF) in Nepalgunj, more than a dozen severely malnourished girls and boys undergo intensive feeding to treat PEM.

“Mothers are surprised that their babies still waste even though they are fed rice and ghee (clarified butter),” says nurse Saraswati Acharya. “It takes a while for them to learn that the kids need proteins which can be had in common food such as legumes and meat.”

Bipana Chaudhary is a severely malnourished 20-month-old from Banke’s Titarihiya village. She was referred to the nutrition centre by the district hospital doctors. She weighed only 3.6 kg when brought to the centre 15 days ago, but now weighs 4.4 kg. “I was feeding her only milk because she did not like anything else,” says Bipana’s mother.

A PEM-stricken child is usually under two years of age and presents with severe wasting, low weight, sunken eyes, pale skin and discoloured hair. If untreated, the child almost certainly dies. The treatment is to feed the child not just rice and milk, but also greens and protein. But the trouble is, many families in Nepal’s western terai plains lack this knowledge.

Kayastha says that he is appalled by the eating habits of locals in Kanchanpur. ”They only eat rice and potatoes. That’s the only thing they grow here, even though the land is vast and fertile. Even common vegetables like onion and garlic are imported from across the Indian border. Same with fruits and greens. People of this region rarely used to eat a balanced diet. Protein was almost non-existent in their diet. But that is now changing slowly.”

The change is too slow to positively affect already-ill children and women. Locals say the diet of Kanchanpur is a reflection of the customs and feeding habits of families in the nearby hill districts of Dadeldhura, Doti, Baitadi, Bajhang, Achham and others from where many have migrated to the plains of Kanchanpur. “We hills-people did not have a culture of eating a balanced diet. We only ate rice and potatoes,” says Nar Bahadur Saud, a local resident.

Custom too plays a role. For instance, many traditional families bar sick women from eating anything other than rice and salt. “I know this is wrong, but my old parents wouldn’t allow my wife any proteins and fruit when she was anaemic,” says Saud. He resolved the problem by admitting her to the zonal hospital, and constantly feeding her meat, fruits and vegetables.

Traditions like these make Kanchanpur the district in Nepal with the highest rate of non-trauma-related blood transfusion (to treat anaemia) among women and children.

But there is hope now. Just as in Banke, the NYOF is funding a nutritional centre in Kanchanpur too. A new building is being erected at the zonal hospital to treat the children. “We will be providing both treatment as well as awareness programmes for mothers,” says Som Paneru, NYOF’s country director. “If we can only educate the mothers that the normal food they eat is good enough for children, that the kids should get more than just rice and milk, then we have half won the battle against malnutrition.”

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