Gilgit-Balitistan Urban-Rural Infant and Young Child Feeding and Under-nutrition
Adequate nutrition during infancy and early childhood is essential to ensure the growth, health, and development of children to their full potential. Poor nutrition increases the risk of illness, and is responsible, directly or indirectly, for one third of the estimated 9.5 million deaths that occurred in 2006 in children less than 5 years of age. (WHO, 2008) Pakistan has one of the highest rates of maternal and child under-nutrition in the world. According to WHO’s survey, 2011, 30% of children under five are mal-nourished however, this survey does not include Gilgit-Baltistan (GB). Another nationwide survey was done in 2011, including GB, by UNICEF and the Aga Khan University (AKU), showed the following data: only 8% of all children aged 6 to 23 months received a minimum acceptable diet nationwide. Among children under five 43.7% were stunted, and 31.5% underweight. Also micronutrient deficiencies were widespread in children such as Anemia 61.9%, Iron deficiency 43.8%, Vitamin A deficiency 54%, Zinc deficiency 39.2% and Vitamin D deficiency 40%. (Aga Khan University, 2011)
There may be multiple reasons behind mal-nutrition and micro-nutrition deficiencies, but this study focused on diets of young children and feeding habits of infants. We have very limited to no data about health status of the residence of GB. As GB doesn’t have provincial status and therefore is left out of the surveillance. It is importance to examine GB rural-urban division on child nutrition and potentially helpful for authorities and the local population. In addition, it is important to intervene in dietary habits of local people to reduce high rates of nutrition deficiencies and to provide awareness about importance of balanced diet for young children, as most of the brain grows in first five years of a person’s life. It is importance to examine GB rural-urban division on child nutrition. Potentially it may helpful for health professionals and local people to have an eye bird view about the health status of GB. To have mentally sound and physically healthy individuals we must have proper diet in the early age.
Current Health Status: A Public Health Issue In Gilgit-Baltistan
Macronutrients are required in large amounts that provide the energy needed to maintain body functions and carry out the activities of daily life. Carbohydrates, proteins and fats are the main macro-nutrients. Table1 shows macro-nutrients intake of infants less than 2 years old in Gilgit-Baltistan, which shows that protein intake by infant, is satisfactory but carbohydrate intake is very less and fat intake, is very high as compare to WHO recommendations. (Farida et al, 2015)
||Average amount of Macro-nutrients consumed per day by infants >2yrs
Table 1: Average amount of Macro-nutrients consumed per day by infants >2yrs in Gilgit-Baltistan with reference to WHO recommendations
Micro-nutrients are needed by body in very tiny amount and they are necessary for the healthy functioning of every system in the body and are vital for good health. Lack of micro-nutrients causes severe health problems. According to WHO, “Iodine, vitamin A and iron are most important in global public health terms; their lack represents a major threat to the health and development of populations.” (WHO, 2015) Survey data shows that in Gilgit-Baltistan infants >2yrs of age have better supply of Calcium, Iron, Riboflavin, Vitamin K, Magnesium, and Zinc. However, Vitamin A, Vitamin C, Vitamin E and Dietary Fiber intake is less as compared to WHO’s recommendations and needs to be taken care in order to better growth of infants and young children. (Farida et al, 2015)
According to World Health Organization exclusive breastfeeding should be 100% to ensure better growth of baby. It means that infants up to six months should only be fed mother’s milk. Only after six months liquid food should be introduce to infants up to 8 months and then only small quantity of solid food can be given to infants. The below pie graphs show the results of breastfeeding behaviors in rural and urban divisions of Gilgit-Baltistan. The trend of exclusive breastfeeding reported in rural areas is only 58% and in urban areas 72%. It suggest that public health professional and health sector should arrange awareness programs about the importance of exclusive breastfeeding in rural and urban Gilgit-Baltistan. (Farida et al, 2015)
Objectives Of intervention for better nutrition of Infant in Gilgit Baltistan:
This Project aims to understand infant and young child feeding practices, diets and growth among infants and young children from rural and urban division of Gilgit-Baltistan. Our project has focused on the following concerns:
- How the infants are faring nutritionally and diet-wise?
- What is infant growth status in reference to WHO in the locations surveyed?
- How does the GB infant feeding measure up in terms of the WHO infant and young child feeding recommendations and indicators?
- Provide knowledge about infant feeding and growth in rural and urban communities.
- Gain sensitivity for the constraints, complexities and challenges of trying to work on an actual research project in a real community.
- Acquire knowledge in the major public health challenges in the South Asian region and other parts of the urbanizing developing world, which constrains the development not only of its young victims, but of their countries as well.
Steps in Identification of MCH Problems:
The nurtiontion intervention were will carried out after a proper surveys in the target community. After several training and standardization sessions in ethics consideration, survey methods, infant nutrition, and anthropometric measurement, mothers and caregivers of infants and young children age <2 years will be interviewed in their local language about infant feeding and childcare and their household situation. Informed consent will be taken from the subjects before the interviews. During the survey, we will also check and begin to code the data and start enters it into databases at home after the survey. Questions about feeding and childcare practices have been adapted from WHO indicators for complementary feeding. The infants’ recumbent lengths and weights will be measured according to standard procedures to ascertain growth status. After data is collected, we will continue to enter, manage and analyze the data and prepare to report back to the local community. Immediately after surveying caregivers, we will give them brief feedback about infant feeding according to their information and theirs’ child’s growth measurements.
Suggested measures: Survey results suggest that an immediate nutrition awareness intervention should be carried out in Gilgit-Baltistan. The researchers request health professionals, health care centers, hospitals, NOGs, INGOs and government of Gilgit-Baltistan to take pragmatic actions to make common people aware about the importance of proper breastfeeding and nutrition of young children and infants in Gilgit-Baltistan
Recruitment of Manpower:
Awareness: The project aims to provide immediate, brief counseling about the importance of proper feeding and balanced diets to local people at their doorstep. Therefore, public health professional should be hired to promote and educate people about importance of proper nutrition and balance diet to their children. Targeted population will be parents having infants and young children below the age of 2 years in rural an urban Gilgit-Baltistan.
In addition to this, all principal investigators and research assistants should attend all mandatory training and IRB workshops for this project. To fulfill all requirements to complete this project with minimal bias, first of all surveys should be completed with respect to IRB requirements. During project researchers should keep regular reflection journal to write about their experience of working in research field. Researchers should summarize and analyze things which they learnt during field work and share their concerns with supervisors. On regular bases principal investigators and research assistants should report back their project to advisors. At the end of project researchers should submit final evaluation of project, their personal reflective journals and record of outcomes achieved according to the project’s aim and peer evaluation of each group member’s contributions to advisors. Finally, a report on the study should be published in local newspaper for the benefit of local community.
Involvement of community:
This project helps researchers to apply academic learning in flied work since they have chance to experience actual research work in a real community. This research will contribute to work on issues of nutrition in local population. Selected community members will receive some professional training and coaching from trained researchers so that in future they can use this knowledge to benefit their peers in the time of need.
Involvement of other sectors: The survey reports will be submitted to local health ministry for making future health policies and better plans for that community. It helps to understand the bigger picture of mal-nutrition among young children and infants in Gilgit-Baltistan.
The research findings will be helpful to change or promote the feeding habits in children and can be used to raise awareness among the people of Gilgit-Baltistan about proper nutrition to their infants.
Findings of this research can be used to compare the eating habits of children in different areas of Pakistan or around the world in comparison to Gilgit-Baltistan. The research findings can be used by other researchers interested to have thorough research on the nutrition or malnutrition.
Evaluation Plan of Suggested Measures:
According to study the health and nutritional status of mothers and children are intimately linked. Improved infant and young child feeding begins with ensuring the health and nutritional status of women. Therefore to ensure a healthy baby mothers’ health is very important. The health policy makers should involve mothers in nutrition intervention and encourage school teachers to initiate physical activities in school. Since young children spend considerable amount of time at school. To have evaluation of the nutrition interventions in community researchers should select research assistants from the community who should monthly report the progress of intervention and the challenges to the researchers and health ministry. Public health professionals should visit the intervention community once in a while to monitor the program.