Challenges and progress in evaluating the introduction of a water, sanitation, and health component into a treatment program for children with severe acute malnutrition in Dadu, Sindh Province, Pakistan
In Pakistan, malnutrition remains a big health challenge. It’s correlated with high levels of poverty, and it’s evident in low rates of food consumption and also inadequate nutrient intake. Malnutrition is linked to morbidity and mortality, and its impact on young children in the nation’s rural Sindh Province has become alarming.
At Action Against Hunger, it is our goal to continuously evaluate our programs in the hopes of enhancing them and helping more people achieve positive health outcomes. Here in Sindh, we have partnered with the Johns Hopkins Bloomberg School of Public Health and received funding from the Research for Health in Humanitarian Crises grant. Our research evaluates the effectiveness of three water treatment devices—ceramic filters, Aquatabs, and PUR sachets—as components added to community management of acute malnutrition (CMAM) interventions. We currently operate outpatient therapeutic program (OTP) sites to treat child undernutrition in the Dadu area, and this study on the impacts of adding in a safe drinking water program component is being tested out at 20 of these sites.
Our staff is busy enrolling participants, measuring children with severe acute malnutrition, demonstrating water treatment devices, conducting health and hygiene promotion activities, maintaining participant records, following up with and monitoring participants’ health, and doing exit interviews with participants.
Research like this is never without its challenges. We are working in government health units, with considerable limitations in terms of space and resources. There is limited furniture for us to use while collecting data. It is worthwhile, however, because working in these facilities allows us and the government employees to get to know one another better, share opinions, and develop an important professional rapport.
Another challenge stems from local concepts about undernutrition. There is limited health education through the health system or the media, and many people don’t have access to well-stocked health facilities. Because of this, people often use traditional methods to combat undernutrition in children. Some people pass their baby underneath a camel’s leg two or three times in an attempt to cure the child. Others weigh the baby using taaraji, locally-made spring scales. In this method, they place the baby on one side of the balance and on the other side place shoes instead of iron weights. With the passage of time people are moving away from these practices and seeking other methods to cope with malnutrition; however, these traditions remain in some parts of Dadu. For these reasons our screening teams face challenges in some villages in encouraging families to enroll at the OTP sites.
Lastly, climate and local conditions can pose a barrier. Summer temperatures in Dadu often exceed 120 degrees Fahrenheit (50 degrees Celsius), posing a number of challenges for our team. Continuing to collect data at OTP sites and in the field in these conditions is challenging, but our team is dedicated and well-motivated despite the intense heat.
Working through these obstacles is well worth it, as we aim to complete study activities and put our knowledge into action. We hope that the results of the study will better inform how CMAM programs can become more effective. We’ll keep you apprised when we have the results in hand.