A Nutrition Education Intervention to Combat Undernutrition: Experience from a Developing Country

Introduction. Undernutrition in children is a major public health concern in Pakistan. A number of interventions which focused only on providing nutrient supplementation have failed to change child undernutrition status during the last 2 decades. The present study aimed to assess the impact of nutrition education on the nutritional status of children living in resource-limited environments. Methods. Subjects were 586 children from Tando Jam and Quetta, Pakistan, aged from 6 months to 8 years. Children were characterized as mild, moderate, or severely wasted on Z-scores. Anthropometry and 24-hour dietary recall were used for nutritional assessment. Intervention strategy was nutrition counselling targeting mothers. Primary outcome was decrease in the severity of wasting and changes in the feeding practices. Results. Nearly 36% children in Tando Jam and 32% children in Quetta progressed to a normal nutritional status. There was a significant increase in the number of meals taken per day (Tando Jam— /Quetta— ). In Tando Jam, significant increase was reported in the intake of high starch food items, vegetables, and fruits ( ). In Quetta, significant increase was noted in the intake of plant protein ( ), dairy foods ( ), and vegetables ( ). Conclusion. Nutrition education was successful in reducing undernutrition in food insecure households. 1. Introduction In Pakistan, undernutrition is a major public health concern and an important underlying factor for the high infant and under 5 mortality rate. Undernutrition is common among all sections of the Pakistani population, but is of greatest consequence in young children. The country has one of the highest rates of infant mortality in South Asia (61.27？deaths/1,000？live？births) [1]. The findings of Pakistan demographic and health survey 2006-2007 highlight the fact that the country’s rate of infant and child mortality has hardly changed in over a decade [2] and the undernutrition status has remained unchanged for almost two decades [3]. The National Nutrition Survey (NNS) of Pakistan (2011) reports malnutrition estimates of less than ？2 Z-scores in children under five years of age as underweight 31.5%, wasting 15%, and stunting 43.7% [3]. The NNS-2011 also reported childhood undernutrition levels to be higher in rural areas with the risk rising significantly for children between 12 and 35 months of age and for the children of older mothers, whereas the risk appears lower for children given food earlier than one year. There is no doubt that poverty is an important risk factor for undernutrition in Pakistan, but