Ariya Shrestha, a 21-month-old infant from Sindupalchok, is severely malnourished. Her mother, Riya, 25, had taken Ariya to the Nutritional Rehabilitation Home for treatment but she is still skinny and has shown no improvement.
After giving birth, Riya could not breastfeed her daughter for two days. The local health official asked Riya to feed her daughter Lactogen, a popular infant formula. She did everything she was asked to do, but Ariya was diagnosed as malnourished and weighed only five kilograms when she was a year old.
“I did whatever I could and fed her what doctors asked me to, but her health did not improve. I had undergone multiple tests, which returned fine. I do not know why my daughter is malnourished,” says Riya, adding she did not take iron supplements regularly during her pregnancy.
Chautara Sangachokgadhi municipality’s Kanchhi Tamang is also worried that her two-year-old daughter is malnourished. She also visited the Nutritional Rehabilitation Home and was asked to stay there for a fortnight. But she could not due to family issues and returned in three days. Tamang only went for tests three times during her pregnancy and was irregular with iron supplements.
According to Pragati Bhandari, a staff nurse at Chautara Nutritional Rehabilitation Home, seven malnourished babies have been brought into the home in the past nine months. Two were so severely malnourished; it recommended the family take the babies to Kanti Children’s Hospital in Kathmandu.
There are many babies in Chautara Sangachokgadhi municipality who are malnourished. In the last year alone, the municipality saw 20 cases of acute malnutrition and 220 cases of malnutrition. In the first nine months of this year, there have been 11 cases of acute malnutrition and 64 cases of malnutrition in Chautara Sangachokgadhi municipality.
Sindupalchok is a district often plagued by natural disasters. It has been prone to landslides and floods, which result in many people having to relocate. According to government data, over 1,007 households had to be relocated due to the 2015 earthquake. Then, with landslides occurring every year, the number of homes to be relocated goes up every year.
But Sindhupalchok is not the only district hit by frequent disasters in Nepal. And, experts say these disasters have a direct relationship with malnutrition.
Malnutrition and disasters in Nepal
If one looks at government data, the number of malnutrition cases is more in areas like Tripurasundari, Balephi and Barabise in Sindhupalchok, which are often plagued by floods and landslides, the most common natural disasters in Nepal.
When Savita Thami from Tripurasundari rural municipality gave birth to her son Samudra, he weighed less than two kilograms. Sumudra is now 13 months old and weighs around six kilograms.
Not reaching the specified weight is an indicator of malnutrition. The acutely malnourished child has been undergoing treatment for three weeks at the Nutritional Rehabilitation Home.
“He is diagnosed with malnutrition. His health improved when he was kept here,” says staff nurse Bhandari.
Thami has two daughters aged 12 and 6. When they were born, they looked malnourished, but they never underwent a nutrition test.
“It was home birth. I did go to the health post a few times, but that was it. I stopped taking the iron supplements after giving birth,” says Thami.
Doctors say a pregnant woman should go get tested up to eight times. If they give birth at a government birthing centre, there is even a provision to pay for transportation. Women should also take iron supplements during the entire pregnancy and until 45 days after they give birth, along with Vitamin A.
But women in Sindupalchok have not been doing that due to various reasons, resulting in a spike in malnutrition cases over the years.
Take Balephi rural municipality for example. According to Jamuna Chaulagain, the head of the health section of the rural municipality, it has recorded around 22 cases of malnutrition in the area including one severely malnourished case.
Most families with child malnutrition have some common problems. Mothers are married at a young age, families are poor and they are less educated. This results in the mother and the child not getting enough care during and after pregnancy. The families having to live in fear of being relocated does not help either.
According to Sindhupalchok Health Office, there are 14,626 children under the age of two. Out of them, 29 were diagnosed with malnutrition in 2019/20, 45 in 2020/21 and 68 in 2021/22.
In fiscal year 22/23, the number went up significantly with severe and malnutrition cases going up to 796. According to Anup Adhikari, head of Sindhupalchok Health Office, 26 children have been severely malnourished and 322 malnourished in the current fiscal year.
According to Adhikari, most malnourished children are given free treatment at the Nutritional Rehabilitation Home in Chautara. This year, 19 children have been cared for at the rehabilitation home, he says.
According to health officials, child malnutrition cases are more in illiterate households. Child malnutrition cases are significantly low when the child’s mother is educated, say health officials.
Similar cases can be found in Sindupalchok’s neighbouring district Rasuwa too. Birmaya Tamang, 23, from Rasuwa’s Uttargaya rural municipality had to relocate due to the earthquake. She has two daughters and a son. Her younger daughter is 20 months old and was diagnosed with malnutrition in a test conducted in December 2022.
This is the shared story of malnourished children and their mothers who were displaced and living in camps after the 2015 earthquake, the biggest event among all natural disasters in Nepal in the past decade. Around 1,148 families were displaced from Rasuwa due to the earthquake.
The pandemic pressure
Looking at the data of the Sindhupalchok Health Office, nutrition tests were seldom done during the Covid pandemic. Health officials say the tests were not done as regularly as in previous years as the staff was dealing with the pandemic. Moreover, people were afraid to come to the health posts for tests for the fear of contracting the virus.
“It is clear that we did not conduct nutrition tests. People’s minds were elsewhere due to the pandemic as many families were more bothered about putting food on the table,” says Ramroshan Yadav, the statistics officer of the health office. “We’ve often seen a trend that people forget about child nutrition whenever there are natural disasters in Nepal.”
Many families displaced by the 2015 earthquake still do not have access to health services and the Covid pandemic made it even harder for them. Following that, they did not have enough access to nutritious food for lactating mothers and their children, and the number of malnutrition cases started to increase.
Siti Tamang, an earthquake-displaced health worker, says many children in the camp had been diagnosed with dysentery, skin diseases and malnutrition.
“The number of malnutrition cases significantly increased during the pandemic,” she says.
During the same time, members of the women’s group started to learn how to know if a child is malnourished through their pulses, she says. “I do that too.”
Rawuwa is home to multiple camps where people have relocated to. One is in Bogatitar in Uttargaya rural municipality. There are nine children under the age of 12, out of whom four are malnourished.
Malnourished children were also found in Naukunda rural municipality in January.
Those who do not live in the camp but were affected by the earthquake also have malnourishment cases. The number is not high. For example, the camp with Gosaikunda rural municipality recorded one case of malnourishment last year, and non reported so far this year.
In Rasuwa’s Gatlang village, three cases of severe malnutrition were recorded and all underwent treatment, says health chief Nima Lama.
“Regular follow-up is being done. We have been telling people how important proper nutrition is for both the mother and the child and raising awareness,” says Lama.
Uttargaya rural municipality’s health office chief Rabindra Thakuri says early marriage is also contributing to malnutrition. Most of the women in remote areas get married at an early age and as their body is not ready for babies, they give birth to malnourished children.
Even in the cases above, many got married before 17 and they did not undergo any tests either. Nor did they take iron and other supplements regularly. The camps often change too as they regularly relocate fearing another disaster, resulting in a lack of care for both the mother and the child.
According to the Rasuwa Health Office, 4,857 children should have undergone nutrition tests, but due to the lockdown and the pandemic, 4,287 children did not undergo these tests. There are 5,370 children below the age of two in Raswa.
So how many of them are malnourished? The office does not have the exact detail as the Health Management Information System (HMIS) has not been updated by the local government.
Persistent problem
Looking from the outside, the money spent on a multi-sectoral nutritional plan seems quite high. But in Rasuwa and Sindupalchok, the districts worst hit by disasters in Nepal, the reality is different as they do not have proper food to eat let alone nutritional food.
Health workers advise parents of malnourished children to feed them nutritious food and increase care. But it is difficult for the parents to put two meals on the table regularly as most of them are daily wage workers.
“We don’t have jobs here to earn. How can we afford good food for our children? We hardly get enough to eat two meals a day working on hydropower projects. It’s very hard,” says Buti Tamang from Uttargaya rural municipality.
The constitution includes the right to housing as a fundamental right of citizens. However, due to the earthquake, the relocation of the displaced families was delayed for seven years. So they are still forced to live in temporary huts. They do not have land to grow food. Purna Ghale, the leader of the displaced, says that they have no means of earning a living.
Among the various causes of malnutrition in the Rasuwa district, a lack of food appears to be a major cause. What does not help is that the district does not have land suitable for agriculture. The Agriculture Office states that about 1,500 metric tons of food grains are insufficient in Rasuwa every year.
Thus, in districts where food production is low, it seems that pregnant women, senior citizens and children are more vulnerable during disasters in Nepal. Locals say that it is difficult to gather nutritious food and eat regularly during the calamity.
The Nepal Demographic and Health Survey 2016 has highlighted the progress in the health of mothers and children in two decades. In the report, the death rate of children under five years of age was 118 per 1,000 in 1996, and it tripled down to 39 in 2016.
In order to achieve Sustainable Development Goals, Nepal has to reduce the under-five mortality rate to 20 per 1,000 live births by 2030.
This story was translated from the original Nepali version and edited for clarity and length.
