Bajura : A 21-month daughter of Aina Sarki, who lives in Bajura district headquarter Martadi, was taken to District Hospital Bajura after she was taken ill in April, 2019. The Hospital declared that she was suffering from malnutrition. The weight of Pawan, a 14-month old son of Laxmi Devi Nepali of Khaptad Chhededah Rural Municipality-5, was just six kilogram. Nine-month old daughter of Saura Dhami of the same village also suffered from malnutrition. A 10-month old Sangeeta Dhami of the same municipality is also a victim of severe malnutrition. A large number of children in Bajura district, which lags far behind in terms of poverty index, are suffering from malnutrition.
Malnutrition is one of the major concerns for the country. The consequences of malnutrition are far-reaching and irreparable ones. Children suffering from malnutrition are highly vulnerable to various diseases. They cannot succeed academically. They often drop out of schools and make little progress in learning activities. Normally, these children are not able to make good earning even when they are adult. As such, the issue of malnutrition is the problem of individual, society and the country as a whole. This problem is additionally severe in Bajura district, which lags far behind in terms of poverty index.
Status of Malnutrition
According to District Health Office, Bajura, all nine municipalities and rural municipalities in the district have children suffering from malnutrition. As many as 108 of children– the highest number of children among all municipalities and rural municipalities in the district– were found suffering from malnutrition in Swami Kartik Khapra Rural Municipality and a total of 3 children– the lowest among all– were found suffering from malnutrition in Gaumul Rural Municipality in the district (See Table 1).
Statistics of District Health Office show that the number of children suffering from malnutrition is gradually decreasing. The number of children suffering from the malnutrition during the fiscal year 2018/19 stood at 517. In the previous fiscal year, the number was 984 that included 239 children suffering from severe and 745 others suffering from moderate malnutrition. The statistics showed that the number of children suffering from malnutrition in the fiscal year 2016/17 was 1,378 including 400 of those suffering from severe malnutrition and 978 others from moderate malnutrition.
Table 1. Situation of Malnutrition in Municipalities and Rural Municipalities in Bajura district
|S.No.||Rural Municipalities/Municipalities||Number of Children Undergoing Medical Check Up||Children Suffering from Severe Malnutrition||Children Suffering from Moderate Malnutrition||Total Children Suffering from Malnutrition|
|1.||Himali Rural Municipality||212||25||39||64|
|2.||Goumul Rural Municiapality||212||1||2||3|
|3.||Budhi Nanda Municipality||484||24||83||107|
|4.||Swami Kartik Khapar Rural Municipality||385||29||79||108|
|5.||Jagannath Rural Municipality||667||10||78||88|
|6.||Badimalika Rural Municipality||637||7||25||32|
|7.||Khaptad Chheddaha Rural Municipality||514||6||27||33|
|8.||Budhi Ganga Municipality||417||27||24||51|
Ground Reality is Different
Although statistics show that the number of children suffering from malnutrition in Bajura is decreasing, facts on the ground suggest otherwise. As for instance, only a three-year old Phoolchana Nepali of Amkot Village in Budhi Ganga Municipality-1 in the district, according to the statistics of District Health Office, Bajura, and Bramhatola Health Post. However, most children of 60 Dalit families suffer from malnutrition in the village. Suchana Nepali, a two-year old younger sister of Phoolchana, is also suffering from malnutrition. But she is not included in the official statistics of the children suffering from malnutrition, as she has never been taken to health posts for treatment. “Phoolchana was taken to hospital after she was seriously taken ill,” said her mother Mankala Sanai. She said that all her seven children were raised under the condition of malnutrition.
Setu Nepali of the same village has three children, namely four-year old Elisha, one and half year old Babita and three-month old Parbati. All three children are suffering from moderate malnutrition. Food is barely enough in her House. The family cannot even sustain for three months with the crops they harvest each year. She is feeding her family with the rice they could buy from the market. Nepali is one among the Golden 1000-Day Mothers. According to the Implementation Procedure of the Golden 1000-Day Mothers, 2070 BS, the period of first two years since a mother gives birth to a child is considered as Golden 1000-Day. Both mother and newbornbaby should get adequate balanced and nutritious food during this period. The Golden 1000-Day Mother program has been implemented in various villages including Kolti, Pandusen, Martadi, Dahakot, Budhi ganga, Kailashmadou, Kuldebmadou, Dogati and Budhi ganga in the district. But Nepali, who lives below extreme poverty line, remains far beyond the access of this program. She said that no one even taught her the recipe to prepare rice porridge, let alone providing her other support.
The 18-year old Devi Nepali has one and half year old daughter and a four-month old son. Although the health condition of her son is relatively better, her daughter is suffering from severe malnutrition. She said that her daughter is suffering from malnutrition due to lack of adequate nutritious food and short birth interval between her two children. She believes that most children in her village are suffering from malnutrition.
Local woman activist Tara Nepal estimates that some 70 percent of the total children in this village that has a total 60 household suffer from malnutrition. Most of these households have food barely enough for six months a year. She argues that it is impossible to provide nutritious food to the family as they struggle to have enough food to eat throughout the year. Family members of these households do not even have basic awareness that they should eat nutritious food.
Health Coordinator of Budhi ganga Municipality Deepak Shah admits to this fact. “We may find large number of children suffering from malnutrition if we start searching them in the villages. But only the number of those visiting health posts for treatment is being recorded,” he said.
Dogadi Health Post In-Charge Dal Bahadur Rawat said only the children who are vulnerable to deaths after suffering from severe malnutrition are brought to health posts for treatment. Acting Chief of District Public Health Office, Bajura Ashok Singh also admits that they have statistics of only those who visit health posts for treatment. “It is difficult to find any household in Bajura district that does not have any members suffering from malnutrition if we make a minute observation in each village,” he said.
Nature and causes of malnutrition
The effects seen in the body after one fails to receive necessary balanced food for a long period of time is malnutrition. Children right since their birth to four years of age require foods that contain 1320 calorie. But the children eating food containing less than the required calorie suffer from malnutrition and those having food consisting more than the required calorie also suffer from malnutrition due to excessive nutrition. Human body requires various nutrients such as protein, carbohydrate, fats, minerals and vitamins. The deficiency of these nutrients causes people to suffer from malnutrition. And, children in particular are more vulnerable to malnutrition than adult persons.
Malnutrition is mainly of two types, namely under nutrition and over nutrition. Mostly, the children in the poor and underdeveloped countries are victims of malnutrition. Over nutrition than necessary is another form of malnutrition. This kind of malnutrition is found both in underdeveloped and developed countries.
Under nutrition has affected children the most. Wasting, stunting, underweight and sunken eyes are some of the external symptoms caused by low level of nutrition. Under nutrition adversely affects mental health of children. This reduces their immunity power, makes them mentally weak, and affects normal their growth as well.
According to UNICEF Nepal, children, their family and society as a whole stand to benefit in the long-term if investment is made on the nutrition of children in their early age. Only 47 percent of children aged between 6 to 23 months receive balanced diet in Nepal. Of them, 36 percent children do not even receive basic minimum level of nutrition, according to UNICEF Nepal.
Statistics of Nepal Demographic and Health Survey conducted in 2016 show that one third of children below five years in Nepal are found stunted. Similarly, the survey showed that stunted growth was observed among 49 percent children of the families living under extreme poverty and 46 percent children of illiterate mothers.
The UNICEF and Demographic and Health Survey have maintained that poverty is the main factor behind the malnutrition in Nepal. Inability of people to get adequate food to eat causes malnutrition. If we make simple calculation of statistics at the global level, children are suffering from malnutrition in the countries where there is poverty and underdevelopment. Along with these two factors, gender discrimination, poor sanitation and lack of awareness also act as secondary causes of malnutrition.
Female Children are at Greater Risk of Malnutrition
Kali BK of Swami kartik Khapar Rural Municipality-2 had provided proper care when her son was born. Family also provided proper care to her. However, she has had an experience that the family instead of providing proper care despised her when she gave birth to a daughter. She said that her daughter also suffered from malnutrition as she was denied nutritious food and proper care from the family.
Chairperson of Women’s Rights Forum, Bajura, Rukhmani Shah said that female children are more vulnerable to malnutrition as family stops providing proper care to both mother and children right since the day a female child is born. Even [educated persons like] teachers are found to have made discrimination after a daughter is born,” she said. According to District Health Office, Bajura, malnutrition is found highly prevalent among female children as family provides proper care and even mother chooses to breast feed for a long time when son is born, but both family and mother chooses to ignore her when a daughter is born.
Dogati Health Post In-Charge Dal Bahadur Rawat said more female children are found suffering from malnutrition as family feeds the male children several times a day and provides proper care, but denies same things to female children. Female children of even one-month of age are often left alone at home and they are breast-fed only after mother returns home after work. According to Rawat, more than 90 percent female children of his work areas suffer from malnutrition. He believes that discrimination that exists between male and female child has led female children to suffer highly from malnutrition.
The statistics of District Health Office, Bajura, released in 2074 BS also mentions that female children are highly affected by malnutrition. According to the statistics, the number of female children is 401 from among the total 640 children suffering from severe malnutrition. Similarly, 742 children are female from among 1353 children suffering from moderate level of malnutrition.
Child marriage is another reason of malnutrition. The children born from mothers who are married below 18 years of age are more vulnerable to malnutrition. Those who give birth even before they are physically and mentally matured do not have awareness to take care of pregnancy stage. This causes children to suffer from malnutrition even when they are in their mother’s womb. In addition to this, these adolescent mothers themselves grow up under malnutrition as a result of gender discrimination. As such, the children born from such mothers are likely to suffer more from malnutrition.
Acting Chief of District Health Office Ashok Singh said wasting, stunting, underweight and physical thinness are observed highly among children in the district. Health Assistant at Kolti Primary Health Post Lokendra Neupane said children in Bajura districts are suffering from malnutrition due to various reasons including lack of nutritious food, health treatment, sanitation and awareness, proper care and diet during pregnancy stage, balanced diet and deficiency of iodized salt. According to a survey conducted by District Health Office, some 60 per cent children do not even get Jiwan Jal and Zinc Tablet. Similarly, less than 10 per cent children receive foods that contain protein such as meat and eggs.
Bajura has earned an identity as a district with highest number of poor people. Although the district receives huge amount of budget in different headings, the money is not utilized properly. According to Human Development Index Report 2015 and National Census conducted in 2011, 64.1 per cent of the total population in the district lives below poverty line. According to the report prepared by Poor Household Support Coordination Board under Ministry of Poverty Alleviation in 2072 BS, Bajura has 71.1 per cent poverty. Then Director of the Poor Household Support Coordination Board Ram Hari Gaire said 35 per cent of the total population in the district lives below extreme poverty line, 22 per cent in medium poor and 24 others are generally poor. The office had identified poverty rate on the bases of various 18 indexes. The study has shown that the highest number of poor among all municipalities and rural municipalities in the district live in Swami Kartik Rural Municipality.
It is not just Bajura district, but entire Province 7 suffers from extreme poverty and it is increasing instead of decreasing. According to a survey conducted in 2011, poverty rate in Far East Province stand at 44.6 percent. This has increased to 47.1 percent 10 years later, according to Central Bureau of Statistics.
Coordinator of Bajura District Coordination Office Narendra Kumar Rokaya believes that poverty is the main factor behind large number of children suffering from malnutrition. Health Volunteer Ramita Neupane also believes that poverty is to be blamed for high prevalence of malnutrition among children. “It is difficult to make even two square meal. They have to sleep without eating anything some days. Rest and nutritious diets are things even beyond their imagination,”said Luti Nepali of Swami Kartik Khapar Rural Muncipality-1, Sappata.
Table 2: Poverty Rate in Rural Municipalities and Municipalities in Bajura
|S. No.||Local Body||Poverty Rate/Percentage and Family||Total Families|
|1.||Tribeni Municipality||64.7 percent/1864 households||2881 households|
|2.||Badimalika Municipality||53.9 percent/1287 households||2,386 households|
|3.||Budiganga Municipality||54.7 percent/2029 households||3,706 households|
|4.||Budhinanda Municipality||67.1 percent/ 2017 households||3,600 households|
|5.||Goumul Rural Municipality||32.7 percent/447 households||1,365 households|
|6.||Jagannath Rural Municipality||69.4 percent/1093 households||1,574 households|
|7.||Swami Kartik Rural Municipality||75 percent/1838 households||2,185 households|
|8.||Khaptad ChhedDaha Rural Municipality||68 percent/1989 households||2,911 households|
|9.||Himali Rural Municipality||74.5 percent/1265 households||1,697 households|
|Source: Poor Household Support Coordination Board, Kathmandu|
The life expectancy of people in Nepal is 69.2 years. However in case of people in Bajura, this is just 59.5 years. The situation that around 14 percent of mother in Bajura do not even live beyond 40 years is heart-wrenching. According to Chief of District Health Office, Bajura, Dr Rup Chandra Bishwakarma, most people in Bajura have low life expectancy and poor health as a result of poverty.
A district with 7.5 percent landless people, 38.7 percent of the total households have enough food to eat for three months and 27.4 percent for six months. Only 4.4 percent of the total households have enough food to eat throughout the year, according to Agriculture Development Office, Bajura. Although the there is a need of 23,364 metric tons of food for a year in the district, average production of foods in the district is enough for just about four months. This is the reason why Bajura is known for food shortage every year.
The use of food in producing alcohol is another reason that causes food shortage in the district. According to Chief of District Police Office, Bajura, Uddhav Bhat, a huge amount of alcohol is produced in the district each year. Instead saving food, large amount of food is used to produce alcohol. The District Police Office, Bajura, had seized 12,000 liters of home made alcohol from mid-October, 2018 to mid, April 2019. Civil society leader Laxman Joshi said males in the districts are ready to spend money for buying alcohol than buying vegetables and milk. Tek Bahadur Dhami of Bajura District Chamber of Commerce and Industry said the sale of alcohol in the district each month amounts between Rs 15 million to Rs 20 million. “Alcohol is one among other major reasons that has made people poor,” said Joshi.
Efforts Are Underway, but Achievements Are Too Little
As various programs implemented by the government to alleviate poverty have failed to reach to the targeted groups, the situation of poverty has further exacerbated. Poverty Alleviation Fund (PAF) has invested over Rs 400 million in the far-western region alone. The Fund has been providing loan through its revolving fund to carry out some income generating activities. But the loan has not been properly utilized, according to civil society leader Sher Bahadur Shahi of Bajura. Also, the loan the PAF extended is less likely to be recovered.
In 2011, a Multi-Sectoral Nutrition Program was implemented to reduce the situation of malnutrition in the district. In addition to this, various government and non-government organizations including UNICEF has been working in the field of nutrition since a long time ago. In line with the objective to bring down malnutrition to zero by 2025, various efforts are also being made at the level of government and non-government organizations. But the achievements of these initiatives have been less than satisfactory.
Alleviation of poverty can help to get rid of the vicious cycle of malnutrition. But reducing extreme poverty in the district has proved to be a big challenge. More than 90 percent people in the district are dependent on agriculture. But due to failure to introduce commercial farming, it has been difficult to take expected benefits from the agriculture and uplift the living standards of people in the district. Youths in the districts are forced to go to neighboring India and various Gulf countries for works. Although various initiatives are being taken at the level of government and non-government organizations to help achieve the target set by Nepal to bring down malnutrition to zero by 2025, the situation of malnutrition among children in this district shows that it is very challenging to achieve this national goal within the stipulated deadline.