Report by: Fayza Khan, President, Pakistan Nutrition and Dietetic Society

The death toll in the famine-hit Tharparkar region from drought, at least 464 children have died in Tharparkar over the last nine months, including 32 children during October – November 2014 as media report. Malnutrition and unavailability of immediate treatment and care at homes was cited as the main cause of these deaths. PNDS realizing its national and social responsibility has decided to set-up its Relief Camp at Tharparkar district. Main objective of the camp is to assess the nutrition situation and to set up strategy to help the affected population to combat Malnutrition. First camp was organized on 13th November 2014 at a remote village named HARYAAR and second camp was organized on 9th January 2015 at another village named BHORILO.

As reported by previous survey reports, there is no source of fresh water available in the district Tharparkar Desert region. The economy of the people in Tharparkar is largely dependent on raising Live stocks and millet cultivation if there is some rain. Low rainfall during last three years resulted in local crop failure, coupled with outbreak of sheep pox among livestock. Additionally, the death of large number of small livestock is associated with serious lack and deficiency of food for the animals. Most of the population of Tharparkar has minimal access to social services including improved water source, food source and healthcare. The ongoing drought is having highly negative impacts on the food security and nutrition situation of rural communities. Several factors have contributed to increasing food insecurity, including significant losses of livelihoods to the drought for rural communities, and reduced cereal stocks across the region. The hike in fuel prices is resulting in high food prices that make basic food items inaccessible to drought-affected households. Insufficient access to food, acute lack of access to safe water storages, lack of adequate hygiene practices, and low access to health services worsen already high malnutrition rates, and increase the risk of disease outbreaks. Tharparkar district has the lowest Human Development Index in Sindh (in 2005 it was 0.3140).

 Access to Health care: Cost of travel to nearest health facility is between PKR 1,000 to PKR 4,000. Travel time to the nearest facility is 2– 4 hours

Water availability: The main source of water for households and livestock is deep communal wells, which are mostly brackish. Sanitary toilets are non-existent, with open defecation being a common practice. According to local communities, the water table is currently adequate.

First Camp at Haryaar

Haryaar Village was on 30 minutes’ road drive from Mithi. Mostly comprises of Hindu community. There was no health facility available in that area. Camp was organized at a only a local girls school consisted of two rooms, which was nonfunctional due to non-availability of staff and other facilities. The purpose of this activity was to assess current situation of the people at Tharparkar in terms of food availability, intake, other resources and its effects on health Team of eight PNDS members including four nutritionists, two dietitians and two pediatricians volunteered their services for this camp. Mr. Hans Masroor Badvi arranged logistics and was in contact with the local communities.

Those Infants and children who visited the camp were assessed for malnutrition most of the children were found to be underweight. After initial consultation provided by Pediatricians, children and mothers were referred to the nutritionist for nutrition counseling. Mothers were counseled for homemade weaning food and hygiene and sanitation. During counseling session nutritionists provided them cost effective tips for homemade food. Pregnant and lactating mothers were also counseled for healthy diet and to improve their dietary intake at low cost. Food items were distributed among mothers and children included mineral water bottles, milk packs, nutritional supplements, Cream biscuits, Spaghettis, peanuts, roasted daal, Soji halwa, Butter and Jam sachets. Vit A & D, Zinc syrups, ORS was also provided as per needs of the children and their mothers. By taking diet history the following observations were made by the team members.

 

Second Relief Camp by PNDS

 There were a no of villages where there is no access of road and regular transport cannot run in the dessert area so Jeaps and camels are used to reach there. For second relief camp, our team decided to organize camp at a more distant village named Bhorilo which was on 1 hour and 40 minutes’ drive by road from Mithi city of the district.

Volunteers from Dhoraji Youth Services Foundation (DYSF) help us to organize the camp at BHORILO.

Women having children less than five years were invited to the camp. Children were measured for weight, height & MUAC.A brief questionnaire was also filled related to dietary intake & vaccination and history of diseases & current complaints by the help of the translator who was communicating with the mothers in their local language. After reviewed by the pediatrician the mother was counseled by the nutritionist regarding safe and appropriate feeding practices. Vit A & D drops, Zinc, multivitamins & iron syrups were given to the mothers and children as per their need. Sample were prepared by the local women

Key Observations by PNDS team members:

  •  Wells and water reservoirs were found dried and empty .Wood is used as fuel and when it is unavailable mostly raw milk is consumed.
  • Bread (roti) and chatni (mainly green chilies) was found as stable food.
  • Among those who visited the camp, Infants and children who were 6 months and older even upto 2 years were only fed mother milk and mothers were not aware of homemade weaning diet for children above 6 months of age .Dietary intake is limited to roti, tea & chatni among children and adults. The consumption of fruits and a vegetable is almost nil due to high cost and unavailability. It was found that fruits and vegetables cannot be grown locally due to unavailability of water.
  • Most of the people including children consume beetle nut (Chalia).
  • It was also identified while taking history that many children eat clay. These children were referred back to the pediatrician for antihelmenthic medication.
  • Head ache was commonly prevalent among women and older adults.

Recommendations by PNDS Team:

Other than to provide them basis necessities of life like drinking water ,food & other resources at Govt. level. There is a desperate need to initiate on going supplementary feeding programs which includes nutritious food in addition to the general ration, aiming to prevent the deterioration of the nutritional state of those who are at risk by meeting their nutritional needs, focusing particularly on young children, pregnant woman, nursing mothers, elderly .Health education and counseling sessions should be the part of program to combat cycle of malnutrition in that region.

 PNDS is thankful to Matrix Pharma for their extended cooperation and support in organizing this camp.